Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP014192 | PA |
NPI | 1003218280 |
---|---|
Provider Name | Jennifer A. Bowman |
First Address | South Charleston, WV 25303-1265 |
Second Address | Mc Murray, PA 15317-5413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2014 |
Last Update Date | 16/12/2021 |