1043469869 NPI number — MS. SHAJUANA BOWMAN CHILD CASE MANAGER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043469869 NPI number — MS. SHAJUANA BOWMAN CHILD CASE MANAGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWMAN
Provider First Name:
SHAJUANA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CHILD CASE MANAGER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
SHAJUANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CHILD CASE MANAGER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043469869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 ROBERTS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTICELLO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71655-5723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-367-2461
Provider Business Mailing Address Fax Number:
870-460-6133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1308 WEST 5TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSSETT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-364-6471
Provider Business Practice Location Address Fax Number:
870-364-9753
Provider Enumeration Date:
09/17/2008

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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