Healthcare Provider Details

I. General information

NPI: 1285052720
Provider Name (Legal Business Name): JONATHAN PENDER MS, NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 STONY POINT PKWY SUITE 110
RICHMOND VA
23235-1962
US

IV. Provider business mailing address

8700 STONY POINT PKWY SUITE 110
RICHMOND VA
23235-1962
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-5501
  • Fax: 804-272-4504
Mailing address:
  • Phone: 804-330-5501
  • Fax: 804-272-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024171637
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: