Provider Demographics
NPI:1568554954
Name:BOWKER, HEATHER J (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:BOWKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:J
Other - Last Name:MCGARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-945-5247
Mailing Address - Fax:207-047-0435
Practice Address - Street 1:735 WILSON STREET
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1003
Practice Address - Country:US
Practice Address - Phone:207-989-1567
Practice Address - Fax:207-989-2287
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER037544363LP0808X
MEAP081139363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM892802Medicare PIN