Provider Demographics
NPI:1558878421
Name:NOVA WOMEN'S HEALTH COLLECTIVE
Entity Type:Organization
Organization Name:NOVA WOMEN'S HEALTH COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERILL
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:760-889-2857
Mailing Address - Street 1:10734 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5122
Mailing Address - Country:US
Mailing Address - Phone:760-889-2857
Mailing Address - Fax:703-563-9226
Practice Address - Street 1:7011 CALAMO ST STE 204
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3510
Practice Address - Country:US
Practice Address - Phone:703-829-6299
Practice Address - Fax:703-563-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01290000126176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty