Provider Demographics
NPI:1790076727
Name:MILBOURN, ANDREA (LPN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MILBOURN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 PONDFIELD RD # D218
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3818
Mailing Address - Country:US
Mailing Address - Phone:646-721-6720
Mailing Address - Fax:
Practice Address - Street 1:553 PALMER RD APT 1W
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-5166
Practice Address - Country:US
Practice Address - Phone:646-721-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275113-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse