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NPI Code Detail

MEDICARE: SALLY MAUCK MORTEMOUSQUE

MEDICARE: SALLY MAUCK MORTEMOUSQUE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1356294920
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY MAUCK MORTEMOUSQUE
Provider Business Mailing Address
First Line : 337 LEXINGTON RD
Second Line :
City : RICHMOND
State : VA
Zip : 23226-1607
Country : US
Telephone Number : 804-339-7764
Fax Number :
Provider Business Practice Location Address
First Line : 1881 UNIVERSITY DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23453-8001
Country : US
Telephone Number : 757-683-4297
Fax Number : 757-683-5253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Directions to “ SALLY MAUCK MORTEMOUSQUE ” Practice Location

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