Provider Demographics
NPI:1669728366
Name:MILLEKER, KATIE SANDBOWER (DIPLOAC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:SANDBOWER
Last Name:MILLEKER
Suffix:
Gender:F
Credentials:DIPLOAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112A ASKEWTON RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4604
Mailing Address - Country:US
Mailing Address - Phone:410-647-7264
Mailing Address - Fax:
Practice Address - Street 1:112A ASKEWTON RD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4604
Practice Address - Country:US
Practice Address - Phone:410-647-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00674171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU00674OtherMARYLAND STATE ACUPUNCTURE LICENCE