Provider Demographics
NPI:1750362851
Name:RICHARDSON, MONICA GRACE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:GRACE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 ARABIAN CIR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-2803
Mailing Address - Country:US
Mailing Address - Phone:757-865-2560
Mailing Address - Fax:
Practice Address - Street 1:MCDONALD ARMY COMMUNITY HOSP
Practice Address - Street 2:WOMEN'S HEALTH CLINIC BLDG 576
Practice Address - City:FT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604
Practice Address - Country:US
Practice Address - Phone:757-314-7606
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001171109163W00000X
DEL1-0008831163W00000X
VA0024164431363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health