Provider Demographics
NPI:1124892724
Name:MILTON, STACEY MARIE
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MARIE
Last Name:MILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3313
Mailing Address - Country:US
Mailing Address - Phone:701-204-3263
Mailing Address - Fax:
Practice Address - Street 1:107 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3313
Practice Address - Country:US
Practice Address - Phone:701-204-3263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant