1346428505 NPI number — FINA BOWIE ANP, GNP

Table of content: FINA BOWIE ANP, GNP (NPI 1346428505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346428505 NPI number — FINA BOWIE ANP, GNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWIE
Provider First Name:
FINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP, GNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MODEST
Provider Other First Name:
FINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346428505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1510 N HAMPTON RD STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DESOTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75115-8310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-909-6874
Provider Business Mailing Address Fax Number:
817-303-3373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1510 N HAMPTON RD
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-8300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-909-6874
Provider Business Practice Location Address Fax Number:
817-303-3373
Provider Enumeration Date:
02/09/2008

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: 363LG0600X , with the licence number:  692038 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 692038 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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