Healthcare Provider Details

I. General information

NPI: 1790364487
Provider Name (Legal Business Name): NICHOLAS CHARLES BOWLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 CARE WAY
FREDERICKSBURG VA
22401-8425
US

IV. Provider business mailing address

3000 SPOUT RUN PKWY APT A406
ARLINGTON VA
22201-4218
US

V. Phone/Fax

Practice location:
  • Phone: 540-374-3131
  • Fax: 540-374-3134
Mailing address:
  • Phone: 540-374-3131
  • Fax: 540-374-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: