Provider Demographics
NPI:1417284175
Name:BOWERS, DEREK NEIL (ACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:NEIL
Last Name:BOWERS
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 NE BRYCE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1640
Mailing Address - Country:US
Mailing Address - Phone:615-330-2032
Mailing Address - Fax:
Practice Address - Street 1:2836 NE BRYCE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1640
Practice Address - Country:US
Practice Address - Phone:615-330-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14568363LA2100X
OR201150020NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care