MEDICARE: MS. CLAIRE VANESSA MYLES CERTIFIED LIFE COACH

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	164W00000X	Licensed Practical Nurse	0002056101	VA

General Provider Information

NPI Number	:	1811631567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CLAIRE VANESSA MYLES CERTIFIED LIFE COACH

Provider Business Mailing Address
First Line	:	450 LITTLE NECK RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5769
Country	:	US
Telephone Number	:	757-621-1977
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 LITTLE NECK RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5769
Country	:	US
Telephone Number	:	757-621-1977
Fax Number	:

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

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	04/27/2022

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