Provider Demographics
NPI:1518967405
Name:BOWEN, JANET WILDER (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:WILDER
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SHIPWASH DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6861
Mailing Address - Country:US
Mailing Address - Phone:919-662-7600
Mailing Address - Fax:919-662-7675
Practice Address - Street 1:22 SHIPWASH DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6861
Practice Address - Country:US
Practice Address - Phone:919-662-7600
Practice Address - Fax:919-662-7675
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC212959FMedicare ID - Type Unspecified
NCE65989Medicare UPIN