Provider Demographics
NPI:1023324506
Name:MILJOUR, ROBERT RAYMOND (PMHNP-BC, MS, RN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:RAYMOND
Last Name:MILJOUR
Suffix:
Gender:M
Credentials:PMHNP-BC, MS, RN
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3020 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:273 RIDGE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14218-1222
Practice Address - Country:US
Practice Address - Phone:716-929-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY634131163WG0000X
NY402793363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice