Healthcare Provider Details

I. General information

NPI: 1598119422
Provider Name (Legal Business Name): BROOKE WEHAUSEN D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7813 SHRADER RD
HENRICO VA
23294-4210
US

IV. Provider business mailing address

7813 SHRADER RD
HENRICO VA
23294-4210
US

V. Phone/Fax

Practice location:
  • Phone: 804-264-4545
  • Fax: 804-264-4260
Mailing address:
  • Phone: 804-264-4545
  • Fax: 804-264-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0102205993
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: