Healthcare Provider Details

I. General information

NPI: 1225603160
Provider Name (Legal Business Name): MONA BRENNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONA MAHARAJ

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8006 DISCOVERY DR STE 300
RICHMOND VA
23229-8600
US

IV. Provider business mailing address

445 CHARLES H DIMMOCK PKWY STE 100
COLONIAL HEIGHTS VA
23834-2990
US

V. Phone/Fax

Practice location:
  • Phone: 804-495-2299
  • Fax:
Mailing address:
  • Phone: 804-520-1764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024180414
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: