Healthcare Provider Details

I. General information

NPI: 1912258260
Provider Name (Legal Business Name): ASHLEY LORETTA MIRMAK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY LORETTA ALLEN

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 GREENBRIER PKWY STE 100
CHESAPEAKE VA
23320-3697
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-7390
  • Fax: 757-410-7395
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024172326
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: