Provider Demographics
NPI:1972561694
Name:CLOR, THERESA E (NP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:E
Last Name:CLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6900 FOREST AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1729
Mailing Address - Country:US
Mailing Address - Phone:804-249-8888
Mailing Address - Fax:804-249-7246
Practice Address - Street 1:6900 FOREST AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1729
Practice Address - Country:US
Practice Address - Phone:804-249-8888
Practice Address - Fax:804-249-7246
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA17001722363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-1739189OtherFED TAX ID
VA10125618Medicaid
VA54-1739189OtherFED TAX ID
VA10125618Medicaid