Healthcare Provider Details

I. General information

NPI: 1821746488
Provider Name (Legal Business Name): JUDY MARIE MILLIANO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DRIVE
COLUBMBIA MO
65212-1000
US

IV. Provider business mailing address

1 HOSPITAL DR RM GE-05
COLUMBIA MO
65212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 573-771-7214
  • Fax:
Mailing address:
  • Phone: 573-771-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1401X
TaxonomyPediatric Critical Care Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: