Healthcare Provider Details

I. General information

NPI: 1437286523
Provider Name (Legal Business Name): REBECCA GUSMUS WRIGHT CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA GUSMUS WRIGHT- BOWDEN CPNP

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 HARRIS RD
KILMARNOCK VA
22482-3845
US

IV. Provider business mailing address

86 HARRIS RD
KILMARNOCK VA
22482-3845
US

V. Phone/Fax

Practice location:
  • Phone: 804-435-2651
  • Fax: 804-435-2302
Mailing address:
  • Phone: 804-435-2651
  • Fax: 804-435-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0024096876
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: