Provider Demographics
NPI:1972088797
Name:MILAM, ALYSSA N (FNP-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:N
Last Name:MILAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHASE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23924-1139
Mailing Address - Country:US
Mailing Address - Phone:434-372-5141
Mailing Address - Fax:
Practice Address - Street 1:946 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHASE CITY
Practice Address - State:VA
Practice Address - Zip Code:23924-1139
Practice Address - Country:US
Practice Address - Phone:434-372-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001248687163WG0000X
VA0024176873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice