Provider Demographics
NPI:1083149603
Name:BOWLWARE, BROOKE (RD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BOWLWARE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:BOATMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:9933 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5119
Mailing Address - Country:US
Mailing Address - Phone:405-990-5553
Mailing Address - Fax:
Practice Address - Street 1:3325 S BOULEVARD STE 169
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4808
Practice Address - Country:US
Practice Address - Phone:405-990-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1738133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered