Provider Demographics
NPI:1760649156
Name:MILBURN, PATTI
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:MILBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:118 EAST COURT STREET
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-5118
Mailing Address - Country:US
Mailing Address - Phone:217-465-4118
Mailing Address - Fax:217-463-1899
Practice Address - Street 1:118 E COURT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2210
Practice Address - Country:US
Practice Address - Phone:217-465-4118
Practice Address - Fax:217-463-1899
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
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