Provider Demographics
NPI:1073148748
Name:DONTOH, MONICA E
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:E
Last Name:DONTOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4278 MEYERS RD
Mailing Address - Street 2:
Mailing Address - City:TRIANGLE
Mailing Address - State:VA
Mailing Address - Zip Code:22172-1700
Mailing Address - Country:US
Mailing Address - Phone:571-286-2328
Mailing Address - Fax:
Practice Address - Street 1:4278 MEYERS RD
Practice Address - Street 2:
Practice Address - City:TRIANGLE
Practice Address - State:VA
Practice Address - Zip Code:22172-1700
Practice Address - Country:US
Practice Address - Phone:571-286-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001149263163WH0200X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902449291Medicaid
VA82-1228487Medicaid