Provider Demographics
NPI:1093406274
Name:BOWEN, FARRAH
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:
Last Name:BOWEN
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 1:2812 N 5TH ST APT 507
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2356
Mailing Address - Country:US
Mailing Address - Phone:414-865-3475
Mailing Address - Fax:
Practice Address - Street 1:N19W24400 RIVERWOOD DR STE 350
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1182
Practice Address - Country:US
Practice Address - Phone:414-865-3475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver