Healthcare Provider Details

I. General information

NPI: 1518368802
Provider Name (Legal Business Name): ANNETTE KING-MILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNETTE KING-MCNEILL

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ROSEMARY LN
DANVILLE VA
24541-4528
US

IV. Provider business mailing address

119 HAZELWOOD CT
DANVILLE VA
24541-4528
US

V. Phone/Fax

Practice location:
  • Phone: 434-251-1757
  • Fax: 866-707-2744
Mailing address:
  • Phone: 434-251-1757
  • Fax: 866-707-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number2639
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0001154980
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: