Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003307729 |
---|---|
Provider Name | Drea Marie Bowen I |
First Address | Post Falls, ID 83854-9590 |
Second Address | Post Falls, ID 83854-9590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2018 |
Last Update Date | 29/05/2018 |