Provider Demographics
NPI:1609941046
Name:BOWMAN, MICHELLE R (RN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:R
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LOEBIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:230 BEACHCOMBER DR
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-1615
Mailing Address - Country:US
Mailing Address - Phone:805-739-8701
Mailing Address - Fax:
Practice Address - Street 1:212 CARMEN LN
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7769
Practice Address - Country:US
Practice Address - Phone:805-739-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313845163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse