Provider Demographics
NPI:1639717127
Name:BOWRON, CLARA (JD, RN)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:BOWRON
Suffix:
Gender:F
Credentials:JD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1590
Mailing Address - Country:US
Mailing Address - Phone:203-745-6267
Mailing Address - Fax:
Practice Address - Street 1:106 SHORE DR
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1590
Practice Address - Country:US
Practice Address - Phone:203-745-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-15
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8968363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics