Healthcare Provider Details

I. General information

NPI: 1508820705
Provider Name (Legal Business Name): JOEL RUSSELL BUHYOFF CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11848 ROCK LANDING DR
NEWPORT NEWS VA
23606-4425
US

IV. Provider business mailing address

7842 KILLDEE DR
GLOUCESTER PT VA
23062-2122
US

V. Phone/Fax

Practice location:
  • Phone: 757-596-2762
  • Fax: 757-595-2001
Mailing address:
  • Phone: 804-642-9320
  • Fax: 804-642-9320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024103780
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: