Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 2017019292 | MO |
NPI | 1013441013 |
---|---|
Provider Name | Jennifer Nicole Bowler |
First Address | Hannibal, MO 63401-6890 |
Second Address | Hannibal, MO 63401-6890 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2017 |
Last Update Date | 11/09/2019 |