Provider Demographics
NPI:1013381813
Name:PRETORIUS, URSULA JULIANNA
Entity Type:Individual
Prefix:MRS
First Name:URSULA
Middle Name:JULIANNA
Last Name:PRETORIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:URSULA
Other - Middle Name:JULIANNA
Other - Last Name:PALKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, AGNP
Mailing Address - Street 1:600 GRESHAM DR
Mailing Address - Street 2:STE 8630B
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-6115
Mailing Address - Fax:757-275-9998
Practice Address - Street 1:835 GLENROCK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3767
Practice Address - Country:US
Practice Address - Phone:757-252-3294
Practice Address - Fax:757-510-9311
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAAG1014086363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner