MEDICARE: MS. JENA YVONNE MILO I

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1023276532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENA YVONNE MILO I

Provider Business Mailing Address
First Line	:	14460 CRESCENT VALLEY RD SE
Second Line	:
City	:	OLALLA
State	:	WA
Zip	:	98359-9551
Country	:	US
Telephone Number	:	253-857-9051
Fax Number	:	253-857-3141

Provider Business Practice Location Address
First Line	:	14460 CRESCENT VALLEY RD SE
Second Line	:
City	:	OLALLA
State	:	WA
Zip	:	98359-9551
Country	:	US
Telephone Number	:	253-857-9051
Fax Number	:	253-857-3141

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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