MEDICARE: MS. GLORIA MILBOURN P.A.

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	363A00000X	Physician Assistant	1070	NE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669581708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLORIA MILBOURN P.A.

Provider Business Mailing Address
First Line	:	PO BOX 3755
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68103-0755
Country	:	US
Telephone Number	:	402-354-2100
Fax Number	:	402-354-2155

Provider Business Practice Location Address
First Line	:	203 MAIN STREET
Second Line	:
City	:	LOUISVILLE
State	:	NE
Zip	:	68037
Country	:	US
Telephone Number	:	402-354-9050
Fax Number	:	402-234-5202

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/20/2013

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