Provider Demographics
NPI:1023276532
Name:MILO, JENA YVONNE I
Entity type:Individual
Prefix:MS
First Name:JENA
Middle Name:YVONNE
Last Name:MILO
Suffix:I
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 1:14460 CRESCENT VALLEY RD SE
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-9551
Mailing Address - Country:US
Mailing Address - Phone:253-857-9051
Mailing Address - Fax:253-857-3141
Practice Address - Street 1:14460 CRESCENT VALLEY RD SE
Practice Address - Street 2:
Practice Address - City:OLALLA
Practice Address - State:WA
Practice Address - Zip Code:98359-9551
Practice Address - Country:US
Practice Address - Phone:253-857-9051
Practice Address - Fax:253-857-3141
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies