Provider Demographics
NPI:1326790494
Name:BOWEN, SHAWANNA S
Entity Type:Individual
Prefix:
First Name:SHAWANNA
Middle Name:S
Last Name:BOWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 HEISING CT SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-1728
Mailing Address - Country:US
Mailing Address - Phone:330-256-4610
Mailing Address - Fax:
Practice Address - Street 1:1337 HEISING CT SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-1728
Practice Address - Country:US
Practice Address - Phone:330-256-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty