Provider Demographics
NPI:1144627704
Name:DUKES, MONIFA (CNM)
Entity type:Individual
Prefix:MS
First Name:MONIFA
Middle Name:
Last Name:DUKES
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 1:1141 N ROAD ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3354
Mailing Address - Country:US
Mailing Address - Phone:252-338-0101
Mailing Address - Fax:252-562-6252
Practice Address - Street 1:1141 N ROAD ST
Practice Address - Street 2:SUITE I
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3354
Practice Address - Country:US
Practice Address - Phone:252-338-0101
Practice Address - Fax:252-562-6252
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACNM2406176B00000X
NCCNM584367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife