Provider Demographics
NPI:1255368031
Name:MILNES, MARY ALICE (NP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ALICE
Last Name:MILNES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 N STURMER ST
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250-9215
Mailing Address - Country:US
Mailing Address - Phone:304-823-2800
Mailing Address - Fax:304-823-2803
Practice Address - Street 1:210 N STURMER ST
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-9215
Practice Address - Country:US
Practice Address - Phone:304-823-2800
Practice Address - Fax:304-823-2803
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV24775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004181Medicaid
WV511900Medicare ID - Type Unspecified