Provider Demographics
NPI:1578558524
Name:BOWMAN, CHERYL ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:17TH & CHEW STREET
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN164250L163W00000X
PA035823367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0072013500002Medicaid
PA11803094OtherCAQH
PA776396OtherFIRST PRIORITY
PA1544465OtherGATEWAY
PA50007109OtherCAPITAL ADVANTAGE
PA776396OtherHIGHMARK
PA0800370000OtherINDEP. BLUE CROSS
PA0776396OtherKHP CENTRAL
PA82835OtherGEISINGER
PA9083462OtherAETNA
PA776396OtherFIRST PRIORITY
PAS00356Medicare UPIN
PA0072013500002Medicaid