Provider Demographics
NPI:1154474831
Name:BOWYER, PATRICIA LORAINE (OTR, BCN)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LORAINE
Last Name:BOWYER
Suffix:
Gender:F
Credentials:OTR, BCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WHEATON CTR APT 322
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4999
Mailing Address - Country:US
Mailing Address - Phone:630-930-4847
Mailing Address - Fax:
Practice Address - Street 1:3965 75TH ST STE 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7913
Practice Address - Country:US
Practice Address - Phone:630-236-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist