Healthcare Provider Details

I. General information

NPI: 1598488603
Provider Name (Legal Business Name): ANSA GEORGE MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-2163
US

IV. Provider business mailing address

5918 HARBOUR PARK DR
MIDLOTHIAN VA
23112-2163
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax:
Mailing address:
  • Phone: 804-639-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024185251
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: