Provider Demographics
NPI:1073579678
Name:BOWIE, BRENDA MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:MARIE
Last Name:BOWIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:MARIE
Other - Last Name:SPOFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1462
Mailing Address - Fax:
Practice Address - Street 1:1800 CRAIG-KLAWOCK HIGHWAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:AK
Practice Address - Zip Code:99921
Practice Address - Country:US
Practice Address - Phone:907-826-3257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA198446363LF0000X
AK1163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0392791Medicaid
MA0392791Medicaid
MANP1107Medicare ID - Type Unspecified