Provider Demographics
NPI:1568878833
Name:MILBRODT, MISTY SUE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:SUE
Last Name:MILBRODT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:SUE
Other - Last Name:MCMILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:3785 FAIRWAY PARK DR APT 208
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-2994
Mailing Address - Country:US
Mailing Address - Phone:330-265-5840
Mailing Address - Fax:
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204440163W00000X
OHRN.361290-163W00000X
OHAPRN.CNP.024346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse