Provider Demographics
NPI:1013289370
Name:MILTON, SANDRA CHRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CHRISTINE
Last Name:MILTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4632 DURHAM ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:253-448-1248
Mailing Address - Fax:
Practice Address - Street 1:BAS, 110TH CHEMICAL BN (TE)
Practice Address - Street 2:BLDG 16122 D STREET
Practice Address - City:JBLM
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-477-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant