Provider Demographics
NPI:1477144699
Name:BOWMAN, GEOFFREY TYLER (RN)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:TYLER
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E WARD ST APT D-403
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1318
Mailing Address - Country:US
Mailing Address - Phone:219-616-8429
Mailing Address - Fax:
Practice Address - Street 1:250 E WARD ST APT D-403
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1318
Practice Address - Country:US
Practice Address - Phone:219-616-8429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI241099-30163WS0200X
OH241099-30367500000X
WI241099367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WS0200XNursing Service ProvidersRegistered NurseSchool