Provider Demographics
NPI:1124570254
Name:BOWSER, TIA MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:MARIE
Last Name:BOWSER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 CHICKASAW RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:PA
Mailing Address - Zip Code:16259-4011
Mailing Address - Country:US
Mailing Address - Phone:814-229-2343
Mailing Address - Fax:
Practice Address - Street 1:531 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2580
Practice Address - Country:US
Practice Address - Phone:814-938-3977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily