Provider Demographics
NPI:1285619643
Name:POORE-BOWMAN, ANNLISBETH (NP)
Entity type:Individual
Prefix:
First Name:ANNLISBETH
Middle Name:
Last Name:POORE-BOWMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 HEALTH CAMPUS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8679
Mailing Address - Country:US
Mailing Address - Phone:540-689-7400
Mailing Address - Fax:757-963-9617
Practice Address - Street 1:2006 HEALTH CAMPUS DR STE 300
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-7400
Practice Address - Fax:757-963-9617
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024107290363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010197139Medicaid
VA010197139Medicaid
VA00X175C10Medicare PIN