Most Relevant Information
Provider Data
| NPI Number: | 1003663014 |
| Provider Name: | RICKY LEE MILBOURNE CSA, LSA |
| Entity Type: | Individual |
| Taxonomy Code: | 246ZC0007X |
| Specialty: | Specialist/Technologist, Other |
| License Number: | 0136000535 |
Most Important Dates
| Enumeration Date: | 05/06/2024 |
| Last Updated: | 05/06/2024 |
Provider Practice Location
844 BATTLEFIELD BLVD N
CHESAPEAKE
VA
233204802
Practice Location Phone/Fax
| Phone: | 7573126800 |
| Fax: |
Provider Mailing Location
5103 TANGLEWOOD CT
SUFFOLK
VA
234352637
Provider Mailing Phone/Fax
| Phone: | 7039656239 |
| Fax: |