Provider Demographics
NPI:1518364447
Name:VOLRIE, MIA
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:VOLRIE
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 1:1450 E LEAGUE CITY PKWY APT 4304
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6039
Mailing Address - Country:US
Mailing Address - Phone:832-707-4919
Mailing Address - Fax:
Practice Address - Street 1:2660 MARINA BAY DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-4777
Practice Address - Country:US
Practice Address - Phone:832-707-4919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily