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General NPI Number Information
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NPI Number | 1598976094
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Entity Type | Organization
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Legal Business Name | PHYSICANS AND MIDWIVES COLLABORATIVE PRACTICE
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4660 KENMORE AVE 902
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1313
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Country | US
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Telephone | 703-370-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 4660 KENMORE AVE 902
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1313
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Country | US
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Telephone | 703-370-4300
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KATHY ROTH
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Credential | RN
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Telephone | 703-370-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 0017000719
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License Number State | VA
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