Provider Demographics
NPI:1467064758
Name:BOWLES, LORETTA MAE
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:MAE
Last Name:BOWLES
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:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:MEADOW BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25976-0046
Mailing Address - Country:US
Mailing Address - Phone:304-466-5407
Mailing Address - Fax:
Practice Address - Street 1:23 WINGFIELD MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:WV
Practice Address - Zip Code:25985-9230
Practice Address - Country:US
Practice Address - Phone:304-466-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant