Provider Demographics
NPI:1376136861
Name:BOWMAN, AILEEN MARIE (NP STUDENT)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:MARIE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:NP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 HAYES DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1273
Mailing Address - Country:US
Mailing Address - Phone:970-250-7863
Mailing Address - Fax:
Practice Address - Street 1:2523 HAYES DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1273
Practice Address - Country:US
Practice Address - Phone:970-250-7863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO70915390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program