Provider Demographics
NPI:1225474695
Name:BOWMAN, NICOLE RENEE (NP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 INTELLIPLEX DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8580
Mailing Address - Country:US
Mailing Address - Phone:317-421-1914
Mailing Address - Fax:317-398-1853
Practice Address - Street 1:2451 INTELLIPLEX DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8580
Practice Address - Country:US
Practice Address - Phone:317-421-1914
Practice Address - Fax:317-398-1853
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28184614A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily