Provider Demographics
NPI:1316002017
Name:BOWLING, VIRGINA DAWN (FOSTER PARENT)
Entity Type:Individual
Prefix:
First Name:VIRGINA
Middle Name:DAWN
Last Name:BOWLING
Suffix:
Gender:F
Credentials:FOSTER PARENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 W 27TH LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6857
Mailing Address - Country:US
Mailing Address - Phone:928-317-9064
Mailing Address - Fax:
Practice Address - Street 1:2829 W 27TH LN
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6857
Practice Address - Country:US
Practice Address - Phone:928-317-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11030385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child