Healthcare Provider Details

I. General information

NPI: 1730773110
Provider Name (Legal Business Name): ANN CATHERINE KOWNACK C.N.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 KEMPSVILLE RD STE 2200
NORFOLK VA
23502-3990
US

IV. Provider business mailing address

6353 CENTER DR STE 100
NORFOLK VA
23502-4100
US

V. Phone/Fax

Practice location:
  • Phone: 757-466-6350
  • Fax:
Mailing address:
  • Phone: 571-356-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024181031
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: