MEDICARE: MONIQUE WHITEHURST FNP

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
1	363LF0000X	Family Nurse Practitioner	0024184208	VA

General Provider Information

NPI Number	:	1669116828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE WHITEHURST FNP

Provider Business Mailing Address
First Line	:	3352 PRINCESS ANNE RD UNIT S-909
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-2608
Country	:	US
Telephone Number	:	757-707-1231
Fax Number	:

Provider Business Practice Location Address
First Line	:	3352 PRINCESS ANNE RD UNIT S-909
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-2608
Country	:	US
Telephone Number	:	757-707-1231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	04/25/2022

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