1710273495 NPI number — BRENDA LOIS BOWMAN BRENDA BOWMAN

Table of content: BRENDA LOIS BOWMAN BRENDA BOWMAN (NPI 1710273495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710273495 NPI number — BRENDA LOIS BOWMAN BRENDA BOWMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWMAN
Provider First Name:
BRENDA
Provider Middle Name:
LOIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BRENDA BOWMAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOWMAN
Provider Other First Name:
BRENDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BRENDA BOWMAN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710273495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 PEARL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80301-1123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-209-0102
Provider Business Mailing Address Fax Number:
303-209-0102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 PEARL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80301-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-209-0102
Provider Business Practice Location Address Fax Number:
303-209-0102
Provider Enumeration Date:
06/21/2011

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: 183500000X , with the licence number:  13425 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 26016897A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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