Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1101003191 | VA |
NPI | 1215332432 |
---|---|
Provider Name | Rachael Nicole Bowling |
First Address | Aylett, VA 23009-3416 |
Second Address | Aylett, VA 23009-3416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2014 |
Last Update Date | 30/10/2014 |