Provider Demographics
NPI:1023567435
Name:BOWERS, VICTORIA (NP-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 N DYSART RD STE 136
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85307-2232
Mailing Address - Country:US
Mailing Address - Phone:623-215-2525
Mailing Address - Fax:623-215-4555
Practice Address - Street 1:6808 N DYSART RD STE 136
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307-2232
Practice Address - Country:US
Practice Address - Phone:623-215-2525
Practice Address - Fax:623-215-4555
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4019363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care