Individual
KAVANAGH-FAYE MARIE BUSHNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-5000
Mailing address
12204 WEDGEFIELD DR, GRAND ISLAND, FL 32735-8498
(808) 753-1973
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Enumeration date
05/01/2024
Last updated
05/01/2024
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