Provider Demographics
NPI:1275355570
Name:MILLIGAN, MARA LINN (RD,CDCES)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:LINN
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:RD,CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 STONERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507
Mailing Address - Country:US
Mailing Address - Phone:419-350-1953
Mailing Address - Fax:
Practice Address - Street 1:403 STONERIDGE CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507
Practice Address - Country:US
Practice Address - Phone:419-350-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered