Individual
MONICA G TAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2949 WEST FRONT STREET, RICHLANDS, VA 24641
(276) 596-6000
Mailing address
2951 WEST FRONT STREET, SUITE 3050, RICHLANDS, VA 24641
(276) 963-8504
(276) 963-6642
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024083585
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0069719-000
WV MEDICAID
VA
05
—
008932221
—
VA
01
—
430064722
RR MEDICARE
VA
Enumeration date
06/16/2006
Last updated
07/05/2013
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