Provider Demographics
NPI:1922365931
Name:MILTON, NICOLE LYNETTE (LVN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNETTE
Last Name:MILTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-2507
Mailing Address - Country:US
Mailing Address - Phone:323-833-7886
Mailing Address - Fax:
Practice Address - Street 1:7630 DALTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-2507
Practice Address - Country:US
Practice Address - Phone:323-833-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN194610164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse