Healthcare Provider Details

I. General information

NPI: 1083671598
Provider Name (Legal Business Name): DONNA FREDE VINAL CNM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PETER JEFFERSON PKWY SUITE 300
CHARLOTTESVILLE VA
22911-8835
US

IV. Provider business mailing address

600 PETER JEFFERSON PKWY SUITE 300
CHARLOTTESVILLE VA
22911-8835
US

V. Phone/Fax

Practice location:
  • Phone: 434-293-9800
  • Fax: 434-977-0088
Mailing address:
  • Phone: 434-293-9800
  • Fax: 434-977-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberVA0001096715
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberVA0017000483
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: