Provider Demographics
NPI:1881823813
Name:MILLERTON, YVONNE MARIE
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MARIE
Last Name:MILLERTON
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 1:2017 OTTKAMP DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-4440
Mailing Address - Country:US
Mailing Address - Phone:314-393-8311
Mailing Address - Fax:
Practice Address - Street 1:2017 OTTKAMP DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4440
Practice Address - Country:US
Practice Address - Phone:314-393-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-12
Last Update Date:2009-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003025154163W00000X
CA673569163W00000X
OH302094163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse