Healthcare Provider Details

I. General information

NPI: 1073148748
Provider Name (Legal Business Name): MONICA E. DONTOH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4278 MEYERS RD
TRIANGLE VA
22172-1700
US

IV. Provider business mailing address

4278 MEYERS RD
TRIANGLE VA
22172-1700
US

V. Phone/Fax

Practice location:
  • Phone: 571-286-2328
  • Fax:
Mailing address:
  • Phone: 571-286-2328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0001149263
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0001149263
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: