Provider Demographics
NPI:1043452865
Name:BOWEN, SUNNI GAIL (ANP)
Entity Type:Individual
Prefix:MRS
First Name:SUNNI
Middle Name:GAIL
Last Name:BOWEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 MONARCHOS DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-9772
Mailing Address - Country:US
Mailing Address - Phone:405-423-3777
Mailing Address - Fax:
Practice Address - Street 1:4624 MONARCHOS DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-9772
Practice Address - Country:US
Practice Address - Phone:405-423-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN138312163W00000X
TN14066363LA2200X
OK72117363L00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health