Individual
MILISSA DIANE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3700 S MAIN ST, BLACKSBURG, VA 24060-7017
(540) 381-1279
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0017142538
VA
Other
Enumeration date
10/08/2015
Last updated
09/19/2018
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