MEDICARE: MR. JEFFREY LEE MILBURN RN,RNFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	71216	OK

General Provider Information

NPI Number	:	1932127867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY LEE MILBURN RN,RNFA

Provider Business Mailing Address
First Line	:	9332 SW 21ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73128-4927
Country	:	US
Telephone Number	:	405-414-7619
Fax Number	:

Provider Business Practice Location Address
First Line	:	9332 SW 21ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73128-4927
Country	:	US
Telephone Number	:	405-414-7619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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