MEDICARE: ELIZABETH ANN MILBURN CRNP, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ01121800	NJ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP012390	PA

General Provider Information

NPI Number	:	1891048377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN MILBURN CRNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	1528 WALNUT ST STE 1414
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3610
Country	:	US
Telephone Number	:	267-358-6010
Fax Number	:	267-358-6010

Provider Business Practice Location Address
First Line	:	1528 WALNUT ST STE 1414
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3610
Country	:	US
Telephone Number	:	267-358-6010
Fax Number	:	267-358-6010

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

Provider Enumeration Date	:	10/20/2012
Last Update Date	:	08/05/2024

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