Healthcare Provider Details

I. General information

NPI: 1225897077
Provider Name (Legal Business Name): ALEXANDRA LYNN MCMILLEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11958 W BROAD ST
HENRICO VA
23233-1007
US

IV. Provider business mailing address

2152 THOROUGHBRED PKWY
GOOCHLAND VA
23063-3248
US

V. Phone/Fax

Practice location:
  • Phone: 804-360-4669
  • Fax:
Mailing address:
  • Phone: 703-338-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0001282132
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: