Provider Demographics
NPI:1154086304
Name:BOWMAN, REKEEVA YAVETTE
Entity Type:Individual
Prefix:MISS
First Name:REKEEVA
Middle Name:YAVETTE
Last Name:BOWMAN
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 1:3310 COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1859
Mailing Address - Country:US
Mailing Address - Phone:810-341-3344
Mailing Address - Fax:
Practice Address - Street 1:3310 COMANCHE AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1859
Practice Address - Country:US
Practice Address - Phone:810-610-7060
Practice Address - Fax:810-715-9683
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9525495Medicaid