Provider Demographics
NPI:1497743926
Name:BOWERS, ELIZABETH A (FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:BOWERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:BRODERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2369 STAPLES MILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2918
Mailing Address - Country:US
Mailing Address - Phone:804-285-4465
Mailing Address - Fax:804-285-8332
Practice Address - Street 1:201 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-4510
Practice Address - Country:US
Practice Address - Phone:804-285-8206
Practice Address - Fax:804-320-3102
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010005167Medicaid
VA010005167Medicaid
VA000494G73Medicare ID - Type Unspecified