Provider Demographics
NPI:1578781985
Name:BOWN, MELISSA A (ANP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BOWN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 E STATE ST
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1203
Mailing Address - Country:US
Mailing Address - Phone:518-736-1500
Mailing Address - Fax:518-762-8194
Practice Address - Street 1:23 S PERRY ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2316
Practice Address - Country:US
Practice Address - Phone:518-736-1500
Practice Address - Fax:518-762-8194
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302577363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01993677Medicaid
NYJ400173132Medicare PIN