Provider Demographics
NPI:1760901441
Name:GILLIAM-EL, MIASHA
Entity Type:Individual
Prefix:
First Name:MIASHA
Middle Name:
Last Name:GILLIAM-EL
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 1:2100 BERRY ST
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-6412
Mailing Address - Country:US
Mailing Address - Phone:804-943-9929
Mailing Address - Fax:
Practice Address - Street 1:2100 BERRY STREET
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2386
Practice Address - Country:US
Practice Address - Phone:804-943-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001226562163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse