Healthcare Provider Details

I. General information

NPI: 1992917140
Provider Name (Legal Business Name): CYNTHIA PATRICE VALLE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVENUE SUITE 902
ALEXANDRIA VI
22304
US

IV. Provider business mailing address

116 INGLE PLACE
ALEXANDRIA VA
22304
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-4300
  • Fax: 703-370-1683
Mailing address:
  • Phone: 703-823-0047
  • Fax: 703-823-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024118896
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: