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Individual

MS. VERONIKA SAFRONOVNA BUMGARDNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
7915 LAKE MANASSAS DR, SUITE 205, GAINESVILLE, VA 20155-3258
(571) 261-3529
(703) 753-5613
Mailing address
PO BOX 21975, BELFAST, ME 04915-4116
(540) 321-4281
(540) 321-4282

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004522
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
17507967793
VA
01
1750796793
MEDICARE
VA
Enumeration date
06/29/2014
Last updated
05/23/2019
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