Healthcare Provider Details

I. General information

NPI: 1952392060
Provider Name (Legal Business Name): ROBERT DEAN BOWMAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 FARRELL RD
FORT BELVOIR VA
22060-5901
US

IV. Provider business mailing address

9607 THOMAS BAXTER PL
LORTON VA
22079-2354
US

V. Phone/Fax

Practice location:
  • Phone: 703-805-0571
  • Fax:
Mailing address:
  • Phone: 703-943-7068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR018454
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: