Healthcare Provider Details

I. General information

NPI: 1023002722
Provider Name (Legal Business Name): MILBREY RANEY RN GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201B MANCHACA RD
AUSTIN TX
78745-5259
US

IV. Provider business mailing address

7201B MANCHACA RD
AUSTIN TX
78745-5259
US

V. Phone/Fax

Practice location:
  • Phone: 512-443-3577
  • Fax:
Mailing address:
  • Phone: 512-443-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number589779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: