Provider Demographics
NPI:1134736887
Name:MILHOUSE, THERESSA (RN)
Entity type:Individual
Prefix:
First Name:THERESSA
Middle Name:
Last Name:MILHOUSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 MARKET ST STE 2
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2100
Mailing Address - Country:US
Mailing Address - Phone:330-953-2700
Mailing Address - Fax:330-953-2705
Practice Address - Street 1:4845 MARKET ST STE 2
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2100
Practice Address - Country:US
Practice Address - Phone:330-953-2700
Practice Address - Fax:330-953-2705
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
DE08D2191118291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No171M00000XOther Service ProvidersCase Manager/Care Coordinator