Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 71002215A | IN |
NPI | 1003902248 |
---|---|
Provider Name | Ingrid Kay Bowser |
First Address | Goshen, IN 46526-4810 |
Second Address | Goshen, IN 46526-4810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000525959 | ANTHEM (01) | IN |
Q76741 | (02) | IN |