Provider Demographics
NPI:1356380901
Name:MILETO, ANNETTE LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:LOUISE
Last Name:MILETO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:LOUISE
Other - Last Name:MOWRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1205 RIVER AVE FL 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3724
Practice Address - Country:US
Practice Address - Phone:570-323-5991
Practice Address - Fax:570-323-6578
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000336L363A00000X
PAMA002580L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1B2234OtherMEDICARE
PA1031915800003Medicaid
PAP00651175Medicare PIN
PA004600F6KMedicare PIN
PA134876Medicare PIN