Provider Demographics
NPI:1841735883
Name:MILLER, ALEXANDRA GRACE (NP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:GRACE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:GRACE
Other - Last Name:THEES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:NEW CANTON
Mailing Address - State:VA
Mailing Address - Zip Code:23123-0220
Mailing Address - Country:US
Mailing Address - Phone:434-581-3271
Mailing Address - Fax:
Practice Address - Street 1:25892 N JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:NEW CANTON
Practice Address - State:VA
Practice Address - Zip Code:23123-2234
Practice Address - Country:US
Practice Address - Phone:434-581-3271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005394363LF0000X, 363LG0600X
VA0024177245363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology