Individual
MONIQUE BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
648 GRASSFIELD PKWY STE 1, CHESAPEAKE, VA 23322-7465
(757) 312-6797
(757) 410-0390
Mailing address
667 KINGSBOROUGH SQ STE 101, CHESAPEAKE, VA 23320-4999
(757) 842-4481
(757) 312-3135
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110003318
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285945733
OPTIMA
VA
05
—
1285945733
—
VA
Enumeration date
06/30/2010
Last updated
06/20/2024
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