Provider Demographics
NPI:1568522803
Name:MOURNING, DENISE SMITH (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:SMITH
Last Name:MOURNING
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 SOUTHAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1001
Mailing Address - Country:US
Mailing Address - Phone:757-683-2889
Mailing Address - Fax:757-683-2740
Practice Address - Street 1:830 SOUTHAMPTON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1001
Practice Address - Country:US
Practice Address - Phone:757-683-2889
Practice Address - Fax:757-683-2740
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024053273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily