Provider Demographics
NPI:1235112806
Name:BOWDEN, SUE ELLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9507 HOSPITAL AVENUE
Mailing Address - Street 2:P.O. BO X 17
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0017
Mailing Address - Country:US
Mailing Address - Phone:757-414-8702
Mailing Address - Fax:757-414-8335
Practice Address - Street 1:9507 HOSPITAL AVENUE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413-0017
Practice Address - Country:US
Practice Address - Phone:757-414-8702
Practice Address - Fax:757-414-8335
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR158735367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
430075595OtherRAILROAD MEDICARE
MD403673500Medicaid
VAC00228OtherCRNA
VAC00228OtherCRNA