Provider Demographics
NPI:1497010912
Name:CHARMOK, MONICA ANNA
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:ANNA
Last Name:CHARMOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:ANNA
Other - Last Name:WILLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2831 KELLY SQ
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-6143
Mailing Address - Country:US
Mailing Address - Phone:703-255-0085
Mailing Address - Fax:703-255-0085
Practice Address - Street 1:2831 KELLY SQ
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22181-6143
Practice Address - Country:US
Practice Address - Phone:703-255-0085
Practice Address - Fax:703-255-0085
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001090541163W00000X
DCRN1015499163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse