Provider Demographics
NPI:1033509989
Name:BOWTHORPE, ALLYX (APRN)
Entity Type:Individual
Prefix:
First Name:ALLYX
Middle Name:
Last Name:BOWTHORPE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 E 5350 S STE D
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-5417
Mailing Address - Country:US
Mailing Address - Phone:801-827-9100
Mailing Address - Fax:801-827-9110
Practice Address - Street 1:434 E 5350 S STE D
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-827-9100
Practice Address - Fax:801-827-9110
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7212306-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner