Provider Demographics
NPI:1235208216
Name:BOWKER, STACY MARIE (ND)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:MARIE
Last Name:BOWKER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:MARIE
Other - Last Name:THORNDIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:110 CEDAR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2900
Mailing Address - Country:US
Mailing Address - Phone:360-282-4014
Mailing Address - Fax:360-282-4017
Practice Address - Street 1:110 CEDAR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2900
Practice Address - Country:US
Practice Address - Phone:360-282-4014
Practice Address - Fax:360-282-4017
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001309175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1235208216Medicaid