Healthcare Provider Details

I. General information

NPI: 1982471124
Provider Name (Legal Business Name): ANAKA GRACE MILBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL
DAYTON OH
45417-3445
US

IV. Provider business mailing address

105 N MAPLE AVE APT B
FAIRBORN OH
45324-5166
US

V. Phone/Fax

Practice location:
  • Phone: 937-813-1737
  • Fax: 937-813-4834
Mailing address:
  • Phone: 937-751-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberX7E3R5G5
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: