Healthcare Provider Details

I. General information

NPI: 1831388693
Provider Name (Legal Business Name): RENEE ANN MILLIGAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 GREENBELT RD
COLLEGE PARK MD
20740-2001
US

IV. Provider business mailing address

4809 GREENBELT RD
COLLEGE PARK MD
20740-2001
US

V. Phone/Fax

Practice location:
  • Phone: 301-441-9150
  • Fax:
Mailing address:
  • Phone: 301-441-9150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR085633
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN000012084
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number28060800A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: