MEDICARE: DR. ADRIENNE MILLIGAN PLATT CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	2002028643	MO
2	363LP0200X	Pediatric Nurse Practitioner	140607	TX
3	363LP0200X	Pediatric Nurse Practitioner	10170	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003872540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIENNE MILLIGAN PLATT CPNP

Provider Business Mailing Address
First Line	:	36974 BONNIE LAKES RD
Second Line	:
City	:	CROSSLAKE
State	:	MN
Zip	:	56442-3109
Country	:	US
Telephone Number	:	816-835-0929
Fax Number	:

Provider Business Practice Location Address
First Line	:	36974 BONNIE LAKES RD
Second Line	:
City	:	CROSSLAKE
State	:	MN
Zip	:	56442
Country	:	US
Telephone Number	:	816-835-0929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	09/28/2023

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