Provider Demographics
NPI:1659511764
Name:BOWDLER, LORI L (APRN-BC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:BOWDLER
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:PO BOX 9487
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-9487
Mailing Address - Country:US
Mailing Address - Phone:307-733-4585
Mailing Address - Fax:307-733-4787
Practice Address - Street 1:320 E BROADWAY
Practice Address - Street 2:SUITE 1C
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83002
Practice Address - Country:US
Practice Address - Phone:307-733-4585
Practice Address - Fax:307-733-4787
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY176420995363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily