Provider Demographics
NPI:1093756959
Name:BOWHAY-SWEET, JENNIE (NP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:BOWHAY-SWEET
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6340 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2602
Mailing Address - Country:US
Mailing Address - Phone:719-596-0200
Mailing Address - Fax:
Practice Address - Street 1:6340 BARNES RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-2602
Practice Address - Country:US
Practice Address - Phone:719-596-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71326363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03087379Medicaid
479518Medicare ID - Type Unspecified
CO03087379Medicaid