Provider Demographics
NPI:1912258260
Name:MIRMAK, ASHLEY LORETTA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LORETTA
Last Name:MIRMAK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LORETTA
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:824 GREENBRIER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3697
Practice Address - Country:US
Practice Address - Phone:757-410-7390
Practice Address - Fax:757-410-7395
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172326367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1023482965OtherOB/GYN