Healthcare Provider Details

I. General information

NPI: 1013289370
Provider Name (Legal Business Name): SANDRA CHRISTINE MILTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAS, 110TH CHEMICAL BN (TE) BLDG 16122 D STREET
JBLM WA
98433
US

IV. Provider business mailing address

4632 DURHAM ST SE
LACEY WA
98503
US

V. Phone/Fax

Practice location:
  • Phone: 253-477-4830
  • Fax:
Mailing address:
  • Phone: 253-448-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: