MEDICARE: CHRISTINA MICHELLE WRAY MCMILLAN WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	4704234558	MI
2	363LW0102X	Women's Health Nurse Practitioner	0024170041	VA

General Provider Information

NPI Number	:	1669815957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MICHELLE WRAY MCMILLAN WHNP

Provider Business Mailing Address
First Line	:	2865 LYNNHAVEN DR STE A4
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2865 LYNNHAVEN DR STE A4
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1542
Country	:	US
Telephone Number	:	757-496-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	03/16/2023

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