1659314714 NPI number — MRS. LESLEY SONDRA BOWLUS ARNP

Table of content: MRS. LESLEY SONDRA BOWLUS ARNP (NPI 1659314714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659314714 NPI number — MRS. LESLEY SONDRA BOWLUS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWLUS
Provider First Name:
LESLEY
Provider Middle Name:
SONDRA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659314714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1690 DUNLAWTON AVE
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
PORT ORANGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32127-8980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-295-1941
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3512 S ATLANTIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32118-7639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-767-9544
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP710782 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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