Provider Demographics
NPI:1982249181
Name:MILBURN, MICHELLE (RN, MSN, AGNCS-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MILBURN
Suffix:
Gender:F
Credentials:RN, MSN, AGNCS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 ANDERSON HWY
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7506
Mailing Address - Country:US
Mailing Address - Phone:804-379-5233
Mailing Address - Fax:
Practice Address - Street 1:8266 ATLEE RD STE 215
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1805
Practice Address - Country:US
Practice Address - Phone:804-764-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015001087364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist