Healthcare Provider Details

I. General information

NPI: 1063552826
Provider Name (Legal Business Name): JANE MILHOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 SHERIDAN DR
TONAWANDA NY
14150-9407
US

IV. Provider business mailing address

235 CULPEPPER RD
WILLIAMSVILLE NY
14221-3654
US

V. Phone/Fax

Practice location:
  • Phone: 716-838-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number162388
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: