Healthcare Provider Details

I. General information

NPI: 1356571616
Provider Name (Legal Business Name): FEMALE PELVIC MEDICINE INSTITUTE OF VIRGINIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 POLO PKWY
MIDLOTHIAN VA
23113-1453
US

IV. Provider business mailing address

1467 JOHNSTON WILLIS DRIVE
RICHMOND VA
23235
US

V. Phone/Fax

Practice location:
  • Phone: 804-323-5040
  • Fax: 804-323-5070
Mailing address:
  • Phone: 804-323-5040
  • Fax: 804-323-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101230231
License Number StateVA

VIII. Authorized Official

Name: NATHAN L. GUERETTE
Title or Position: OWNER
Credential: MD
Phone: 804-523-2533