Healthcare Provider Details

I. General information

NPI: 1104269273
Provider Name (Legal Business Name): MICHELLE R MILTON ITFS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N CHURCH ST
GREENSBORO NC
27405-4314
US

IV. Provider business mailing address

2500 N CHURCH ST
GREENSBORO NC
27405-4314
US

V. Phone/Fax

Practice location:
  • Phone: 336-375-2240
  • Fax: 336-375-2214
Mailing address:
  • Phone: 336-375-2240
  • Fax: 336-375-2214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: