Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 0024170537 | VA |
NPI | 1013255637 |
---|---|
Provider Name | Melinda Bowles-Childress |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2013 |
Last Update Date | 14/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013255637 | (05) | VA |