Provider Demographics
NPI:1144437864
Name:MILTON, JOAN (DIETITION)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MILTON
Suffix:
Gender:F
Credentials:DIETITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W 7TH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2354
Mailing Address - Country:US
Mailing Address - Phone:509-232-1145
Mailing Address - Fax:509-232-1165
Practice Address - Street 1:910 N WASHINGTON ST STE 209
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2260
Practice Address - Country:US
Practice Address - Phone:509-232-1192
Practice Address - Fax:509-232-1165
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000651133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI00000651OtherLIC