Provider Demographics
NPI:1578118253
Name:BOWEN, JEFFREY LEON (APRN)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEON
Last Name:BOWEN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 S 75 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5220
Mailing Address - Country:US
Mailing Address - Phone:801-915-0107
Mailing Address - Fax:
Practice Address - Street 1:1741 S 75 E
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5220
Practice Address - Country:US
Practice Address - Phone:801-915-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF08190123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily