Provider Demographics
NPI:1184058414
Name:DRAHUSHUK, JENNIE (NP-C)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:DRAHUSHUK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11828 CANON BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2554
Mailing Address - Country:US
Mailing Address - Phone:757-599-4922
Mailing Address - Fax:757-599-4927
Practice Address - Street 1:11828 CANON BLVD STE E
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2554
Practice Address - Country:US
Practice Address - Phone:757-599-4922
Practice Address - Fax:757-599-4927
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily