Provider Demographics
NPI:1003592015
Name:ROWEN, ALEX MICHAEL
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:MICHAEL
Last Name:ROWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 ROCKFORD WEST RD # RF
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45882-9404
Mailing Address - Country:US
Mailing Address - Phone:419-733-1775
Mailing Address - Fax:
Practice Address - Street 1:200 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2494
Practice Address - Country:US
Practice Address - Phone:419-394-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0034190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily