Provider Demographics
NPI:1699179788
Name:BOWEN, DANIELLE M
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:M
Last Name:BOWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 CHERRY HILL CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-6743
Mailing Address - Country:US
Mailing Address - Phone:502-718-0536
Mailing Address - Fax:
Practice Address - Street 1:2010 CHERRY HILL CT
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-6743
Practice Address - Country:US
Practice Address - Phone:812-946-3812
Practice Address - Fax:502-718-0536
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
IN21-014614-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300021130Medicaid