Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP4019 | AZ |
NPI | 1023567435 |
---|---|
Provider Name | Victoria Bowers |
First Address | Glendale, AZ 85307-2232 |
Second Address | Glendale, AZ 85307-2232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2016 |
Last Update Date | 22/11/2016 |