Provider Demographics
NPI:1336352046
Name:MILLIKEN, DEVIN P
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:P
Last Name:MILLIKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ULISKY LN
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16262-9728
Mailing Address - Country:US
Mailing Address - Phone:724-297-3363
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:800-879-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN269965164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse