Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | CNP191153 | ME |
NPI | 1619538782 |
---|---|
Provider Name | Gabrielle Alyson Bowker |
First Address | Saco, ME 04072-1685 |
Second Address | Portland, ME 04103-2659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 27/06/2019 |