Provider Demographics
NPI:1518368802
Name:KING-MILES, ANNETTE
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:KING-MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:KING-MCNEILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:119 HAZELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4528
Mailing Address - Country:US
Mailing Address - Phone:434-251-1757
Mailing Address - Fax:866-707-2744
Practice Address - Street 1:450 ROSEMARY LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4528
Practice Address - Country:US
Practice Address - Phone:434-251-1757
Practice Address - Fax:866-707-2744
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001154980163WA2000X
NC2639376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518368802OtherTRANSPORTATION
VA1518368802Medicaid
VA1518368802OtherTRANSPORTATION
VA1518368802Medicare UPIN
VA1518368802Medicare NSC
VA1518368802Medicare PIN