Healthcare Provider Details

I. General information

NPI: 1821602541
Provider Name (Legal Business Name): HOLLY MAUREEN MILLIGAN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SW DISK DR STE 250
BEND OR
97702-3754
US

IV. Provider business mailing address

1001 SW DISK DR STE 250
BEND OR
97702-3754
US

V. Phone/Fax

Practice location:
  • Phone: 541-859-3550
  • Fax:
Mailing address:
  • Phone: 541-859-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95014652
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number202200107NP-PP
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: