Provider Demographics
NPI:1548253057
Name:HEBERT, MELISSA MILBURN (CFNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MILBURN
Last Name:HEBERT
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:44055 RIVERSIDE PKWY
Practice Address - Street 2:STE 110
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5179
Practice Address - Country:US
Practice Address - Phone:703-724-7530
Practice Address - Fax:703-858-2870
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024138155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA500019794OtherRR MEDICARE
VACG8678OtherRR MEDICARE GROUP PIN
VA07788916Medicaid
VAC06483OtherMEDICARE GROUP PIN
VA07788924Medicaid
VA7788941Medicaid
S58293Medicare UPIN
VACG8678OtherRR MEDICARE GROUP PIN