Healthcare Provider Details

I. General information

NPI: 1649654823
Provider Name (Legal Business Name): LAURA MICHELLE MILAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DEITZ CIRCLE 116
HURRICANE WV
25526
US

IV. Provider business mailing address

500 DEITZ CIRCLE 116
HURRICANE WV
25526
US

V. Phone/Fax

Practice location:
  • Phone: 304-881-2203
  • Fax:
Mailing address:
  • Phone: 304-881-2203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN77958
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: