Healthcare Provider Details

I. General information

NPI: 1649993791
Provider Name (Legal Business Name): MONIKA SUWAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 FAIRFIELD DR
WINCHESTER VA
22602-6838
US

IV. Provider business mailing address

203 FAIRFIELD DR
WINCHESTER VA
22602-6838
US

V. Phone/Fax

Practice location:
  • Phone: 616-717-0318
  • Fax:
Mailing address:
  • Phone: 616-717-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185351
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: