Provider Demographics
NPI:1205182359
Name:BOWERS, SHONDA (FNP)
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5712
Mailing Address - Country:US
Mailing Address - Phone:910-387-3745
Mailing Address - Fax:910-399-4116
Practice Address - Street 1:608 DAWSON ST STE 103
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5712
Practice Address - Country:US
Practice Address - Phone:910-387-3745
Practice Address - Fax:910-399-4116
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005723363LF0000X, 363LF0000X
NC230408363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205182359Medicaid
SCNP3616Medicaid
NCNC7607HMedicare PIN
NCNC7607B592Medicare PIN
NCNC7607BMedicare PIN
NCNC7607FMedicare PIN
SCNP3616Medicaid
NCNC7607IMedicare PIN
NCNC7607EMedicare PIN
NCNC7607GMedicare PIN
NCNC7607AMedicare PIN