Provider Demographics
NPI:1477795110
Name:BOWEN, CHRISTINE N (RD,LD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:N
Last Name:BOWEN
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:N
Other - Last Name:MATTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LD
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-448-6044
Mailing Address - Fax:
Practice Address - Street 1:2801 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3815
Practice Address - Country:US
Practice Address - Phone:162-448-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7133133V00000X
IA001853133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0923187Medicare PIN