Provider Demographics
NPI:1760957278
Name:MILAUSKAS, MAUREEN SUSAN (FNP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:SUSAN
Last Name:MILAUSKAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 ELECTRIC RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-2317
Mailing Address - Country:US
Mailing Address - Phone:540-799-7623
Mailing Address - Fax:540-799-7664
Practice Address - Street 1:2750 TILLETT RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-4034
Practice Address - Country:US
Practice Address - Phone:540-357-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2018007490363LF0000X
VA0024176955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily