Individual
KENNETH WILLAERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 JOHN PAUL JONES CIRCLE, NAVAL MEDICAL CENTER PORTSMOUTH, PORTSMOUTH, VA 23708
(757) 953-2518
Mailing address
PSC 455 BOX 208, FPO, AP 96540-0003, AGANA HEIGHTS, GU 96910
(671) 344-7265
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
0102203583
VA
2083X0100X
Occupational Medicine Physician
Primary
0102203583
VA
Other
Enumeration date
02/24/2012
Last updated
05/10/2022
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