Provider Demographics
NPI:1033662812
Name:BOWER, KATHLEEN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:BOWER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:LAURELDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19605-1701
Mailing Address - Country:US
Mailing Address - Phone:610-921-8034
Mailing Address - Fax:484-334-6520
Practice Address - Street 1:801 E BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:LAURELDALE
Practice Address - State:PA
Practice Address - Zip Code:19605-1701
Practice Address - Country:US
Practice Address - Phone:610-921-8034
Practice Address - Fax:484-334-6520
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004448D363L00000X, 363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001787220Medicare PIN