Provider Demographics
NPI:1043788961
Name:AUSTIN, MYRA LOUISE
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:LOUISE
Last Name:AUSTIN
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 1:8010 RIDGECREST CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-1145
Mailing Address - Country:US
Mailing Address - Phone:434-548-3915
Mailing Address - Fax:434-549-3049
Practice Address - Street 1:8010 RIDGECREST CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-1145
Practice Address - Country:US
Practice Address - Phone:434-548-3915
Practice Address - Fax:434-549-3049
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)