Healthcare Provider Details

I. General information

NPI: 1255368031
Provider Name (Legal Business Name): MARY ALICE MILNES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N STURMER ST
BELINGTON WV
26250-9215
US

IV. Provider business mailing address

210 N STURMER ST
BELINGTON WV
26250-9215
US

V. Phone/Fax

Practice location:
  • Phone: 304-823-2800
  • Fax: 304-823-2803
Mailing address:
  • Phone: 304-823-2800
  • Fax: 304-823-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number24775
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: