Healthcare Provider Details

I. General information

NPI: 1174072193
Provider Name (Legal Business Name): MONA KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD SUITE 311
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

PO BOX 7 SUITE 311
QUINTON VA
23141-0007
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-3550
  • Fax: 804-281-7840
Mailing address:
  • Phone: 804-932-4388
  • Fax: 804-932-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174035
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: