Provider Demographics
NPI:1003329020
Name:BOWEN, MARCELLA (PMHNP)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:1545 CROSSWAYS BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0218
Mailing Address - Country:US
Mailing Address - Phone:757-541-8390
Mailing Address - Fax:484-328-6552
Practice Address - Street 1:809 KENT PL
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0768
Practice Address - Country:US
Practice Address - Phone:757-426-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175576363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health