Provider Demographics
NPI:1659780351
Name:BOWLES, LISA ROSEMARY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ROSEMARY
Last Name:BOWLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ROSEMARY
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1650 28TH ST UNIT 1232
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1013
Mailing Address - Country:US
Mailing Address - Phone:503-684-8252
Mailing Address - Fax:
Practice Address - Street 1:1650 28TH ST UNIT 1232
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1013
Practice Address - Country:US
Practice Address - Phone:503-684-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP15586363LF0000X
COAPN.0991104-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily