Healthcare Provider Details

I. General information

NPI: 1255016655
Provider Name (Legal Business Name): ELSIE MILAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E 600 S
ST GEORGE UT
84770-3949
US

IV. Provider business mailing address

348 E 600 S
ST GEORGE UT
84770-3949
US

V. Phone/Fax

Practice location:
  • Phone: 385-498-9132
  • Fax:
Mailing address:
  • Phone: 385-498-9132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: