Provider Demographics
NPI:1538488523
Name:BOWMAN, ANDREA L (MACOM)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 S SARNOFF DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-1206
Mailing Address - Country:US
Mailing Address - Phone:520-261-5862
Mailing Address - Fax:
Practice Address - Street 1:7225 N MONA LISA RD STE 100A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-4528
Practice Address - Country:US
Practice Address - Phone:520-261-5862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0698171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist