Healthcare Provider Details

I. General information

NPI: 1134140916
Provider Name (Legal Business Name): BONITA KEAVENY DOYLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 FIRST COLONIAL RD
VIRGINIA BEACH VA
23454-3002
US

IV. Provider business mailing address

1265 TANAGER TRL
VIRGINIA BEACH VA
23451-4957
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-8000
  • Fax:
Mailing address:
  • Phone: 757-513-4947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024166420
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: