Provider Demographics
NPI:1669116828
Name:WHITEHURST, MONIQUE (FNP)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3352 PRINCESS ANNE RD UNIT S-909
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-2608
Mailing Address - Country:US
Mailing Address - Phone:757-707-1231
Mailing Address - Fax:
Practice Address - Street 1:3352 PRINCESS ANNE RD UNIT S-909
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-2608
Practice Address - Country:US
Practice Address - Phone:757-707-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily