Healthcare Provider Details

I. General information

NPI: 1548905292
Provider Name (Legal Business Name): DENNISE MICHELLE HEBRON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS DENNISE MICHELLE HARRIS

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD STE 306
RICHMOND VA
23226-1923
US

IV. Provider business mailing address

5855 BREMO RD STE 306
RICHMOND VA
23226-1923
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-7650
  • Fax:
Mailing address:
  • Phone: 804-287-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024183617
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: