Provider Demographics
NPI:1154897890
Name:HORNBACK, EMILY ROSE MILANO (DOM)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ROSE MILANO
Last Name:HORNBACK
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 LINDA DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5616
Mailing Address - Country:US
Mailing Address - Phone:541-610-8873
Mailing Address - Fax:
Practice Address - Street 1:1406 LINDA DR
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5616
Practice Address - Country:US
Practice Address - Phone:541-610-8873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1224171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist