Provider Demographics
NPI:1417046566
Name:BOWMAN, KAREN ANN (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:STE 201
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3900
Mailing Address - Fax:517-913-3901
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:STE 201
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3900
Practice Address - Fax:517-913-3901
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704118158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N55170003OtherMEDICARE PLUS BLUE
MI1059828OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI1059828OtherMCLAREN HEALTH PLAN-MEDICAID
MI1059828OtherMCLAREN HEALTH ADVANTAGE
MI9507249OtherAETNA
MI9507249OtherAETNA
MI1059828OtherMCLAREN HEALTH PLAN-MEDICAID