Provider Demographics
NPI:1205669991
Name:MILBURN, TERI ANNE (LVN)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:ANNE
Last Name:MILBURN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:ANNE
Other - Last Name:PESTOTNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:PO BOX 491542
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-1542
Mailing Address - Country:US
Mailing Address - Phone:530-921-6323
Mailing Address - Fax:
Practice Address - Street 1:10019 OAK RUN RD
Practice Address - Street 2:
Practice Address - City:OAK RUN
Practice Address - State:CA
Practice Address - Zip Code:96069-9613
Practice Address - Country:US
Practice Address - Phone:530-921-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA713212164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty