Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 201906507NP-PP | OR |
N | 363LP2300X | Nurse Practitioner - Primary Care | 201906507NP-PP | OR |
NPI | 1083260830 |
---|---|
Provider Name | Becky L Bowler |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213-2933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2019 |
Last Update Date | 24/09/2020 |