Provider Demographics
NPI:1073938544
Name:BOWE, BETTY JEAN
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:BOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34946-6657
Mailing Address - Country:US
Mailing Address - Phone:772-465-3459
Mailing Address - Fax:772-465-3453
Practice Address - Street 1:2739 CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34946-6657
Practice Address - Country:US
Practice Address - Phone:772-465-3459
Practice Address - Fax:772-465-3453
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11797310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility