Provider Demographics
NPI:1518604230
Name:MILBURN, GINA GAIL
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:GAIL
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 1:901 WINONA BLVD
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052-2011
Mailing Address - Country:US
Mailing Address - Phone:580-560-3705
Mailing Address - Fax:
Practice Address - Street 1:901 WINONA BLVD
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052-2011
Practice Address - Country:US
Practice Address - Phone:580-560-3705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR97413163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice