Healthcare Provider Details

I. General information

NPI: 1548664360
Provider Name (Legal Business Name): BRANDY MOLER MILLAY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E JUBAL EARLY DR
WINCHESTER VA
22601-5178
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 210
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-2232
  • Fax: 540-536-2205
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175562
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61884
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: