Provider Demographics
NPI:1508820705
Name:BUHYOFF, JOEL RUSSELL (CRNA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:RUSSELL
Last Name:BUHYOFF
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7842 KILLDEE DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER PT
Mailing Address - State:VA
Mailing Address - Zip Code:23062-2122
Mailing Address - Country:US
Mailing Address - Phone:804-642-9320
Mailing Address - Fax:804-642-9320
Practice Address - Street 1:11848 ROCK LANDING DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4425
Practice Address - Country:US
Practice Address - Phone:757-596-2762
Practice Address - Fax:757-595-2001
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024103780367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010356172Medicaid
VA010356610Medicaid
VA010356008Medicaid
VA010356491Medicaid
VA010356580Medicaid
011476C37Medicare PIN