Provider Demographics
NPI:1265479398
Name:MONAHAN, DAVIDA FAYE (FNP)
Entity Type:Individual
Prefix:
First Name:DAVIDA
Middle Name:FAYE
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DAVIDA
Other - Middle Name:FAYE
Other - Last Name:BASHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4461 STARKEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0620
Mailing Address - Country:US
Mailing Address - Phone:540-345-4946
Mailing Address - Fax:540-343-7693
Practice Address - Street 1:4461 STARKEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0620
Practice Address - Country:US
Practice Address - Phone:540-345-4946
Practice Address - Fax:540-343-7693
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1265479398Medicaid