Provider Demographics
NPI:1871343830
Name:KUNIHOLM, DOMINIQUE (CNM)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:KUNIHOLM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1907
Mailing Address - Country:US
Mailing Address - Phone:703-946-3859
Mailing Address - Fax:
Practice Address - Street 1:6225 BRANDON AVE STE 175
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2519
Practice Address - Country:US
Practice Address - Phone:703-946-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189527176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife