Individual
NANCY E MISICKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
150 MARKET RIDGE LANE, DALEVILLE, VA 24083
(540) 992-4100
(540) 992-6669
Mailing address
421 STONELEA DR, TROUTVILLE, VA 24175-7195
(540) 966-1222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101231419
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080178195
MEDICARE RAILROAD
VA
05
—
5623332
—
VA
05
—
5626315
—
VA
Enumeration date
11/04/2005
Last updated
10/05/2018
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