Provider Demographics
NPI:1497202196
Name:BOWEN, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BOWEN
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 1:140 WENZ RD
Mailing Address - Street 2:NONE
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6248
Mailing Address - Country:US
Mailing Address - Phone:419-787-6674
Mailing Address - Fax:
Practice Address - Street 1:140 WENZ RD
Practice Address - Street 2:NONE
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6248
Practice Address - Country:US
Practice Address - Phone:419-787-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH27-5164105374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide