Provider Demographics
NPI:1033767413
Name:BUKAUSKAS, EMILY R (NP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:R
Last Name:BUKAUSKAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:R
Other - Last Name:KOPERNIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:15319 EDGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1034
Mailing Address - Country:US
Mailing Address - Phone:540-424-5429
Mailing Address - Fax:
Practice Address - Street 1:4550 EMPIRE CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1939
Practice Address - Country:US
Practice Address - Phone:540-361-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily