Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 4704302358 | MI |
NPI | 1003410697 |
---|---|
Provider Name | Mr. Morgan Bowen |
First Address | Lansing, MI 48915-1909 |
Second Address | Lansing, MI 48911-4252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2020 |
Last Update Date | 24/11/2020 |