Provider Demographics
NPI:1790488898
Name:MILTON, JONATHAN (APNP, ACCNS-AG)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:MILTON
Suffix:
Gender:M
Credentials:APNP, ACCNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4026 COSGROVE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1858
Mailing Address - Country:US
Mailing Address - Phone:309-825-8287
Mailing Address - Fax:
Practice Address - Street 1:900 RIDGE ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1864
Practice Address - Country:US
Practice Address - Phone:608-873-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI232569163WC0200X
WI14939364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine