Provider Demographics
NPI:1790233849
Name:LOPEZ MILIANO, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LOPEZ MILIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3784 RIVERS POINTE WAY APT 5
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-4956
Mailing Address - Country:US
Mailing Address - Phone:347-277-3030
Mailing Address - Fax:
Practice Address - Street 1:3784 RIVERS POINTE WAY APT 5
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-4956
Practice Address - Country:US
Practice Address - Phone:347-277-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY712297163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0800XNursing Service ProvidersRegistered NurseNeuroscience