Provider Demographics
NPI:1831946482
Name:MILONE, GRACE KATHERINE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:KATHERINE
Last Name:MILONE
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 1:1559 SULLIVAN AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2766
Mailing Address - Country:US
Mailing Address - Phone:860-648-5520
Mailing Address - Fax:
Practice Address - Street 1:1559 SULLIVAN AVE FL 1
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2766
Practice Address - Country:US
Practice Address - Phone:860-462-9477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13505363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health