Provider Demographics
NPI:1558641019
Name:BOWMAN, LOIS LAVAUGHN
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:LAVAUGHN
Last Name:BOWMAN
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 1:1524 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3106
Mailing Address - Country:US
Mailing Address - Phone:307-235-1198
Mailing Address - Fax:
Practice Address - Street 1:1524 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3106
Practice Address - Country:US
Practice Address - Phone:307-235-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services