MEDICARE: NOVA WOMEN'S HEALTH COLLECTIVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	01290000126	VA

General Provider Information

NPI Number	:	1558878421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA WOMEN'S HEALTH COLLECTIVE

Provider Business Mailing Address
First Line	:	10734 MAPLE ST
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5122
Country	:	US
Telephone Number	:	760-889-2857
Fax Number	:	703-563-9226

Provider Business Practice Location Address
First Line	:	7011 CALAMO ST STE 204
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-3510
Country	:	US
Telephone Number	:	703-829-6299
Fax Number	:	703-563-9226

Authorized Official
Title or Position	:	MIDWIFE
Name	:	BRITTANY AVERILL
Credential	:	CPM, LM
Telephone Number	:	760-889-2857

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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