Basic Information
| Provider Information | |||||||||
| NPI: | 1851927370 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JUDITH R MILNER MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2230 RUCKER AVE | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982012772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253398023 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2230 RUCKER AVE | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982012772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253398023 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2020 | ||||||||
| LastUpdateDate: | 03/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | MILNER | ||||||||
| AuthorizedOfficialFirstName: | JUDITH | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 4253398023 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 1073675 | 05 | WA | MEDICAID |