Healthcare Provider Details

I. General information

NPI: 1245520626
Provider Name (Legal Business Name): JULIE PURISIMA WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 JAHNKE RD STE 1054
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

PO BOX 403744
ATLANTA GA
30384-3744
US

V. Phone/Fax

Practice location:
  • Phone: 804-231-9691
  • Fax: 804-231-2241
Mailing address:
  • Phone: 804-231-9691
  • Fax: 804-231-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0024169325
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024169325
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: