Healthcare Provider Details

I. General information

NPI: 1205608122
Provider Name (Legal Business Name): MEGAN WREN PHAM CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD STE 401
FREDERICKSBURG VA
22401-4466
US

IV. Provider business mailing address

9805 DANFORD ST
FREDERICKSBURG VA
22407-8369
US

V. Phone/Fax

Practice location:
  • Phone: 540-940-2000
  • Fax: 540-940-2001
Mailing address:
  • Phone: 540-907-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024188548
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: