=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457848798
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNE VICTORIA MONSON CPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2018
-----------------------------------------------------
Last Update Date | 09/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 147 KING LEAR DR
-----------------------------------------------------
City | CHARLES TOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25414-4541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-302-4313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 147 KING LEAR DR
-----------------------------------------------------
City | CHARLES TOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25414-4541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-724-8328
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 0129-000160
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------