Provider Demographics
NPI:1023404571
Name:PILIA, MYCHAL LYNN (CNM)
Entity type:Individual
Prefix:
First Name:MYCHAL
Middle Name:LYNN
Last Name:PILIA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 MONOCACY FORD RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6808
Mailing Address - Country:US
Mailing Address - Phone:210-577-8149
Mailing Address - Fax:
Practice Address - Street 1:7420 HAYWARD ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:210-577-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-11
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001414367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife