Most Relevant Information
Provider Data
| NPI Number: | 1003422163 |
| Provider Name: | KUSUM BHETWAL |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 0024179682 |
Most Important Dates
| Enumeration Date: | 09/23/2020 |
| Last Updated: | 09/23/2020 |
Provider Practice Location
12804 WESTIN ESTATES DRIVE
GLEN ALLEN
VA
23059
Practice Location Phone/Fax
| Phone: | 8043825458 |
| Fax: |
Provider Mailing Location
12804 WESTIN ESTATES DRIVE
GLEN ALLEN
VA
23059
Provider Mailing Phone/Fax
| Phone: | 8043825458 |
| Fax: |