Provider Demographics
NPI:1851987333
Name:MILBURN, NICHELLE LAVETTE
Entity Type:Individual
Prefix:
First Name:NICHELLE
Middle Name:LAVETTE
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 1:109 TREWHILL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-2084
Mailing Address - Country:US
Mailing Address - Phone:337-781-7059
Mailing Address - Fax:
Practice Address - Street 1:109 TREWHILL PARKWAY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-2084
Practice Address - Country:US
Practice Address - Phone:337-781-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator