Provider Demographics
NPI:1093738429
Name:BOW, CURTIS OLIVER JR (NP)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:OLIVER
Last Name:BOW
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 N WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-9510
Mailing Address - Country:US
Mailing Address - Phone:765-281-8982
Mailing Address - Fax:765-281-8982
Practice Address - Street 1:7109 N WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-9510
Practice Address - Country:US
Practice Address - Phone:765-730-0157
Practice Address - Fax:765-281-8982
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001195A363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00841025OtherRAILROAD MEDICARE
IN000000625890OtherANTHEM BC/BS
IN000000657995OtherANTHEM BC/BS
IN000000601828OtherANTHEM BC/BS
IN200503000Medicaid
INP00775276OtherRAILROAD MEDICARE
IN000000601828OtherANTHEM BC/BS
INP00775276OtherRAILROAD MEDICARE
IN000000657995OtherANTHEM BC/BS
IN401730GMedicare PIN
IN265520YMedicare PIN