Healthcare Provider Details

I. General information

NPI: 1568878833
Provider Name (Legal Business Name): MISTY SUE MILBRODT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY SUE MCMILLEN NP-C

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST
AKRON OH
44304-1619
US

IV. Provider business mailing address

3785 FAIRWAY PARK DR APT 208
COPLEY OH
44321-2994
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3000
  • Fax:
Mailing address:
  • Phone: 330-265-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR204440
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.361290-
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024346
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: