Provider Demographics
NPI:1891479713
Name:TATE, MELISSA MILLNER
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MILLNER
Last Name:TATE
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 1:1301 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3305
Mailing Address - Country:US
Mailing Address - Phone:276-732-6381
Mailing Address - Fax:276-201-2479
Practice Address - Street 1:1301 CARDINAL LN
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3305
Practice Address - Country:US
Practice Address - Phone:276-732-6381
Practice Address - Fax:276-201-2479
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)