Healthcare Provider Details

I. General information

NPI: 1992614069
Provider Name (Legal Business Name): MILAN S NETTLES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 MELVILLE ST APT UP
ROCHESTER NY
14609-5428
US

IV. Provider business mailing address

461 MELVILLE ST APT UP
ROCHESTER NY
14609-5428
US

V. Phone/Fax

Practice location:
  • Phone: 585-469-2801
  • Fax:
Mailing address:
  • Phone: 585-469-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number351340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: