Healthcare Provider Details

I. General information

NPI: 1174015382
Provider Name (Legal Business Name): BRITTANY LAINE BOWLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD STE 401
FREDERICKSBURG VA
22401-4466
US

IV. Provider business mailing address

1101 SAM PERRY BLVD STE 401
FREDERICKSBURG VA
22401-4466
US

V. Phone/Fax

Practice location:
  • Phone: 540-940-2000
  • Fax: 540-940-2001
Mailing address:
  • Phone: 540-940-2000
  • Fax: 540-940-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0102207136
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberBP10063477
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: