Provider Demographics
NPI:1174072193
Name:KAUR, MONA
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:SUITE 311
Mailing Address - City:QUINTON
Mailing Address - State:VA
Mailing Address - Zip Code:23141-0007
Mailing Address - Country:US
Mailing Address - Phone:804-932-4388
Mailing Address - Fax:804-932-1003
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE 311
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-287-3550
Practice Address - Fax:804-281-7840
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN