Provider Demographics
NPI:1205428091
Name:MILBURN, SARAH ELIZABETH RUTH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH RUTH
Last Name:MILBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 N MAYFLOWER DR APT 11
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8419
Mailing Address - Country:US
Mailing Address - Phone:920-637-4096
Mailing Address - Fax:
Practice Address - Street 1:748 N MAYFLOWER DR APT 11
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8419
Practice Address - Country:US
Practice Address - Phone:920-637-4096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32465931164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse