Provider Demographics
NPI:1215551213
Name:BOWEN, MARISSA YVONNE (FNP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:YVONNE
Last Name:BOWEN
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 1:3201 W PEORIA AVE STE C500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4600
Mailing Address - Country:US
Mailing Address - Phone:602-402-8048
Mailing Address - Fax:
Practice Address - Street 1:3201 W PEORIA AVE STE C500
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4600
Practice Address - Country:US
Practice Address - Phone:602-402-8048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN183982163W00000X
AZF06200038363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse