Healthcare Provider Details

I. General information

NPI: 1750748877
Provider Name (Legal Business Name): MONICA FREIDLINE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 LAKE MANASSAS DR STE 101
GAINESVILLE VA
20155-3259
US

IV. Provider business mailing address

253 VETERANS DR
WARRENTON VA
20186-3076
US

V. Phone/Fax

Practice location:
  • Phone: 703-743-7300
  • Fax:
Mailing address:
  • Phone: 405-316-5930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024173109
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024173109
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: