Healthcare Provider Details

I. General information

NPI: 1770285132
Provider Name (Legal Business Name): MCKENZIE RABER BOWLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENZIE MAEGAN RABER

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2538
US

IV. Provider business mailing address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2538
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4500
  • Fax: 910-450-4783
Mailing address:
  • Phone: 910-450-4500
  • Fax: 910-450-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102208741
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: