Healthcare Provider Details

I. General information

NPI: 1689498198
Provider Name (Legal Business Name): GABRIELLE ANASTASIA MILIATIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 WESTSHIRE DR
LANSING MI
48917-9764
US

IV. Provider business mailing address

7215 WESTSHIRE DR
LANSING MI
48917-9764
US

V. Phone/Fax

Practice location:
  • Phone: 517-657-2638
  • Fax: 248-712-4381
Mailing address:
  • Phone: 517-657-2638
  • Fax: 248-712-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: