Provider Demographics
NPI:1811791908
Name:MILLEDGE, ERIC SHANE
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:SHANE
Last Name:MILLEDGE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0419
Mailing Address - Country:US
Mailing Address - Phone:712-313-8087
Mailing Address - Fax:
Practice Address - Street 1:5022 S 114TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2329
Practice Address - Country:US
Practice Address - Phone:402-630-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist