Provider Demographics
NPI:1326765405
Name:MCMILLAN, ALISA PATRICE (ACCNS-AG)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:PATRICE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:ACCNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5413 BALFOR DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2408
Mailing Address - Country:US
Mailing Address - Phone:757-776-3455
Mailing Address - Fax:
Practice Address - Street 1:5413 BALFOR DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-2408
Practice Address - Country:US
Practice Address - Phone:757-776-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001222476364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist