Provider Demographics
NPI:1487867024
Name:BOWSER, HOLLI A H (RD CD CDE)
Entity Type:Individual
Prefix:MRS
First Name:HOLLI
Middle Name:A H
Last Name:BOWSER
Suffix:
Gender:F
Credentials:RD CD CDE
Other - Prefix:
Other - First Name:HOLLI
Other - Middle Name:A
Other - Last Name:HALFHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9660 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229
Practice Address - Country:US
Practice Address - Phone:317-963-5937
Practice Address - Fax:317-962-2474
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001571A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN37001571AOtherSTATE LICENSE