Provider Demographics
NPI:1467100297
Name:BOWMAN, MARLENE (CDP)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 LUCKY PINE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-3300
Mailing Address - Country:US
Mailing Address - Phone:773-491-6840
Mailing Address - Fax:
Practice Address - Street 1:677 LUCKY PINE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-3300
Practice Address - Country:US
Practice Address - Phone:773-491-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty