Healthcare Provider Details

I. General information

NPI: 1245292325
Provider Name (Legal Business Name): VICTORIA ANNE BOWER CNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST BOX 159
CHATTANOOGA TN
37403-2103
US

IV. Provider business mailing address

695 CASTLEVIEW DR
RINGGOLD GA
30736-6907
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-6438
  • Fax:
Mailing address:
  • Phone: 423-316-5893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberAPN0000010738
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: