Individual
MR. GARY WAYNE WHITTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN BSN
Contact information
Practice address
77 NEALY AVE., 633RD MDG/SGHM, JOINT BASE LANGLEY-EUSTIS, VA 23665
(757) 764-5246
Mailing address
186 GREEN KEMP RD, VIRGINIA BEACH, VA 23462-3409
(757) 449-1260
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1197143
VA
163WA2000X
Administrator Registered Nurse
Primary
1197143
VA
Other
Enumeration date
08/07/2019
Last updated
07/22/2022
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