Provider Demographics
NPI:1891920856
Name:MILDE, AILEEN ANNE (ATC)
Entity Type:Individual
Prefix:MS
First Name:AILEEN
Middle Name:ANNE
Last Name:MILDE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 TOBY DR
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1822
Mailing Address - Country:US
Mailing Address - Phone:201-230-3895
Mailing Address - Fax:
Practice Address - Street 1:33 TOBY DR
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1822
Practice Address - Country:US
Practice Address - Phone:201-230-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART004439390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program