Provider Demographics
NPI:1609052364
Name:BOWENS, LORA BETH (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:BETH
Last Name:BOWENS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LEE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-3540
Mailing Address - Country:US
Mailing Address - Phone:304-859-2993
Mailing Address - Fax:
Practice Address - Street 1:1143 DUNBAR AVE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3121
Practice Address - Country:US
Practice Address - Phone:304-768-8523
Practice Address - Fax:304-768-8627
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV43053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00656876Medicare PIN