Provider Demographics
NPI:1003825209
Name:BOWLING, AMY RENAE (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RENAE
Last Name:BOWLING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RENAE
Other - Last Name:BOWLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:6429 STAPLETON CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-6459
Mailing Address - Country:US
Mailing Address - Phone:513-844-1828
Mailing Address - Fax:
Practice Address - Street 1:1143 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-9333
Practice Address - Country:US
Practice Address - Phone:937-544-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN102275164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2417405OtherINDEPENDANT PROVIDER NUMB
OHPN102275OtherLPN NUMBER