Provider Demographics
NPI:1427590736
Name:BOWEN, MADONNA (RN)
Entity Type:Individual
Prefix:
First Name:MADONNA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14105 SNOW RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2557
Mailing Address - Country:US
Mailing Address - Phone:216-898-8542
Mailing Address - Fax:216-676-2074
Practice Address - Street 1:14105 SNOW RD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2557
Practice Address - Country:US
Practice Address - Phone:216-898-8542
Practice Address - Fax:216-676-2074
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN286065163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse