Healthcare Provider Details

I. General information

NPI: 1851927370
Provider Name (Legal Business Name): JUDITH R MILNER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 RUCKER AVE
EVERETT WA
98201-2772
US

IV. Provider business mailing address

2230 RUCKER AVE
EVERETT WA
98201-2772
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-8023
  • Fax:
Mailing address:
  • Phone: 425-339-8023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. JUDITH R MILNER
Title or Position: PROPRIETOR
Credential: MD
Phone: 425-339-8023