Healthcare Provider Details

I. General information

NPI: 1558878421
Provider Name (Legal Business Name): NOVA WOMEN'S HEALTH COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 CALAMO ST STE 204
SPRINGFIELD VA
22150-3510
US

IV. Provider business mailing address

10734 MAPLE ST
FAIRFAX VA
22030-5122
US

V. Phone/Fax

Practice location:
  • Phone: 703-829-6299
  • Fax: 703-563-9226
Mailing address:
  • Phone: 760-889-2857
  • Fax: 703-563-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number01290000126
License Number StateVA

VIII. Authorized Official

Name: BRITTANY AVERILL
Title or Position: MIDWIFE
Credential: CPM, LM
Phone: 760-889-2857