Provider Demographics
NPI:1164796272
Name:BOWELL, LISA (ARRT(R)(N), CNMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BOWELL
Suffix:
Gender:F
Credentials:ARRT(R)(N), CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 FLORAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4117
Mailing Address - Country:US
Mailing Address - Phone:406-494-4169
Mailing Address - Fax:
Practice Address - Street 1:1640 W. REDSTONE CENTER DR. SUITE 200
Practice Address - Street 2:SUPPLEMENTAL HEALTH CARE
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7607
Practice Address - Country:US
Practice Address - Phone:888-800-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRRT 04403247100000X
CARHT00085290247100000X
WART 60019537247100000X, 2471N0900X
CARHN 27812471N0900X
RINMT002212471N0900X
MA172432471N0900X
NMNMT 005222471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist