Provider Demographics
NPI:1033172325
Name:BOWE, ELIZABETH B (CNS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:BOWE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:B
Other - Last Name:SEDLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 74647
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0730
Mailing Address - Country:US
Mailing Address - Phone:440-879-0081
Mailing Address - Fax:440-879-0084
Practice Address - Street 1:6780 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2203
Practice Address - Country:US
Practice Address - Phone:440-312-8293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-09
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS-08189364S00000X
OH08791363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2569751Medicaid
OH2569751Medicaid
OHNS75191Medicare ID - Type Unspecified