Provider Demographics
NPI:1003137464
Name:BOWMAN, NICHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:NICHELLE
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 FULLER RD
Mailing Address - Street 2:RADIATION ONCOLOGY 114B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-845-3914
Mailing Address - Fax:734-845-3826
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:RADIATION ONCOLOGY 114B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:734-845-3914
Practice Address - Fax:734-845-3826
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235958163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704235958OtherBOARD OF NURSING REGISTERED NURSE LICENSE