Healthcare Provider Details

I. General information

NPI: 1750362851
Provider Name (Legal Business Name): MONICA GRACE RICHARDSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCDONALD ARMY COMMUNITY HOSP WOMEN'S HEALTH CLINIC BLDG 576
FT EUSTIS VA
23604
US

IV. Provider business mailing address

402 ARABIAN CIR
YORKTOWN VA
23693-2803
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7606
  • Fax:
Mailing address:
  • Phone: 757-865-2560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001171109
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0008831
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024164431
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: