Individual
JACQUELYN KAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
600 GRESHAM DR, NORFOLK, VA 23507-1904
(757) 668-3871
Mailing address
1221 WESTOVER AVE APT B, NORFOLK, VA 23507-1360
(757) 652-9741
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
24049818
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009551590
—
VA
Enumeration date
08/04/2006
Last updated
03/11/2009
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