Provider Demographics
NPI:1942623020
Name:MYLES-MILLS, GIFTY (LPN)
Entity Type:Individual
Prefix:
First Name:GIFTY
Middle Name:
Last Name:MYLES-MILLS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-2629
Mailing Address - Country:US
Mailing Address - Phone:703-310-6765
Mailing Address - Fax:
Practice Address - Street 1:1317 WALKER DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-2629
Practice Address - Country:US
Practice Address - Phone:703-310-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002071991164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse