1992217509 NPI number — AMBY BOWEN BOWEN RN CCM

Table of content: AMBY BOWEN BOWEN RN CCM (NPI 1992217509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992217509 NPI number — AMBY BOWEN BOWEN RN CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWEN
Provider First Name:
AMBY
Provider Middle Name:
BOWEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN CCM
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:
1992217509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 BRIDGEPORT WAY W
Provider Second Line Business Mailing Address:
BOX A-170
Provider Business Mailing Address City Name:
UNIVERSITY PLACE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98466-7521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-722-3430
Provider Business Mailing Address Fax Number:
833-224-3844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 BRIDGEPORT WAY W
Provider Second Line Business Practice Location Address:
BOX A-170
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-7521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-722-3430
Provider Business Practice Location Address Fax Number:
833-224-3844
Provider Enumeration Date:
11/04/2017

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: 163WC0400X , with the licence number:  4207529 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN60051233 , registered in the state of WA ; 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