Healthcare Provider Details

I. General information

NPI: 1649207234
Provider Name (Legal Business Name): LARKIN BRIDGETTE ROWE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11341 SUNSET HILLS RD
RESTON VA
20190-5205
US

IV. Provider business mailing address

11341 SUNSET HILLS RD
RESTON VA
20190-5205
US

V. Phone/Fax

Practice location:
  • Phone: 703-471-0919
  • Fax: 703-742-9081
Mailing address:
  • Phone: 703-471-0919
  • Fax: 703-742-9081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024166844
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: