Healthcare Provider Details

I. General information

NPI: 1386347144
Provider Name (Legal Business Name): VIRGINIA MIDWIFERY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200A TECHNOLOGY CT
CHANTILLY VA
20151-1214
US

IV. Provider business mailing address

17232 PICKWICK DR
PURCELLVILLE VA
20132-3100
US

V. Phone/Fax

Practice location:
  • Phone: 540-709-1737
  • Fax: 866-611-3615
Mailing address:
  • Phone: 240-422-3889
  • Fax: 866-611-3615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: KIM PEKIN
Title or Position: MEMBER
Credential: CPM, RN
Phone: 540-709-1737