Healthcare Provider Details

I. General information

NPI: 1932127867
Provider Name (Legal Business Name): JEFFREY LEE MILBURN RN,RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9332 SW 21ST ST
OKLAHOMA CITY OK
73128-4927
US

IV. Provider business mailing address

9332 SW 21ST ST
OKLAHOMA CITY OK
73128-4927
US

V. Phone/Fax

Practice location:
  • Phone: 405-414-7619
  • Fax:
Mailing address:
  • Phone: 405-414-7619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number71216
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: