Healthcare Provider Details

I. General information

NPI: 1457636755
Provider Name (Legal Business Name): MILEA VIROJANAPA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MILEA EMMONS PA-C

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-5601
  • Fax:
Mailing address:
  • Phone: 513-803-5601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006368RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003566
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number015095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: