Provider Demographics
NPI:1063249233
Name:MILLSPAW, MICHELLE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:MILLSPAW
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4734 KEMPSVILLE GREENS PKWY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6460
Mailing Address - Country:US
Mailing Address - Phone:757-404-8678
Mailing Address - Fax:
Practice Address - Street 1:5511 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3321
Practice Address - Country:US
Practice Address - Phone:757-704-4747
Practice Address - Fax:757-704-5959
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191266363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty