Healthcare Provider Details

I. General information

NPI: 1134736887
Provider Name (Legal Business Name): THERESSA MILHOUSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 01/13/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 MARKET ST STE 2
YOUNGSTOWN OH
44512-2100
US

IV. Provider business mailing address

4845 MARKET ST STE 2
YOUNGSTOWN OH
44512-2100
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-2700
  • Fax: 330-953-2705
Mailing address:
  • Phone: 330-953-2700
  • Fax: 330-953-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number08D2191118
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: