1720656549 NPI number — JA'NETTE LEE MARIE BOWDEN FNP-C

Table of content: JA'NETTE LEE MARIE BOWDEN FNP-C (NPI 1720656549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720656549 NPI number — JA'NETTE LEE MARIE BOWDEN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWDEN
Provider First Name:
JA'NETTE
Provider Middle Name:
LEE MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1720656549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 TOWN FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUCKSPORT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04416-4438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-664-7780
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 RESORT WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04605-1717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-664-7780
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2021

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: 363LF0000X , with the licence number:  CNP211263 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com