Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0024175576 | VA |
NPI | 1003329020 |
---|---|
Provider Name | Marcella Bowen |
First Address | Norfolk, VA 23507-1518 |
Second Address | Norfolk, VA 23507-1518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2017 |
Last Update Date | 13/11/2017 |