Provider Demographics
NPI:1366682551
Name:SPEAK, MONA (DNP, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:
Last Name:SPEAK
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-0556
Mailing Address - Country:US
Mailing Address - Phone:276-546-5600
Mailing Address - Fax:877-765-6483
Practice Address - Street 1:41718 W MORGAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-3224
Practice Address - Country:US
Practice Address - Phone:276-546-5600
Practice Address - Fax:877-765-6483
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily