Healthcare Provider Details

I. General information

NPI: 1649054628
Provider Name (Legal Business Name): KATHERINE MARIE MUNGER BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E LEIGH ST
RICHMOND VA
23298
US

IV. Provider business mailing address

1112 WELBORNE DR
HENRICO VA
23229-5654
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7247
  • Fax:
Mailing address:
  • Phone: 559-901-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001290594
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: