Healthcare Provider Details

I. General information

NPI: 1184372344
Provider Name (Legal Business Name): MONICA CRUM RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GEORGE MASON DR
ARLINGTON VA
22205-3610
US

IV. Provider business mailing address

2813 HOGAN CT
FALLS CHURCH VA
22043-3525
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001224851
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-306469
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: