Healthcare Provider Details

I. General information

NPI: 1023276532
Provider Name (Legal Business Name): MS. JENA YVONNE MILO I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14460 CRESCENT VALLEY RD SE
OLALLA WA
98359-9551
US

IV. Provider business mailing address

14460 CRESCENT VALLEY RD SE
OLALLA WA
98359-9551
US

V. Phone/Fax

Practice location:
  • Phone: 253-857-9051
  • Fax: 253-857-3141
Mailing address:
  • Phone: 253-857-9051
  • Fax: 253-857-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: