Provider Demographics
NPI:1720869381
Name:MILTON, KEONDA
Entity type:Individual
Prefix:
First Name:KEONDA
Middle Name:
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 1:200 REGENCY CT STE L104
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6184
Mailing Address - Country:US
Mailing Address - Phone:262-788-5020
Mailing Address - Fax:
Practice Address - Street 1:200 REGENCY CT STE L104
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-6184
Practice Address - Country:US
Practice Address - Phone:262-788-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide