Provider Demographics
NPI:1700187200
Name:BOWSER, ELLEN K (MS,RD,LD/N,RN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:K
Last Name:BOWSER
Suffix:
Gender:F
Credentials:MS,RD,LD/N,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PEDIATRIC PULMONARY DIVISION
Mailing Address - Street 2:BOX 100296
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0296
Mailing Address - Country:US
Mailing Address - Phone:352-273-8380
Mailing Address - Fax:
Practice Address - Street 1:PEDIATRIC PULMONARY DIVISION
Practice Address - Street 2:BOX 100296
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0296
Practice Address - Country:US
Practice Address - Phone:352-273-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND1982133V00000X
FLRN1370312163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEP925ZMedicare PIN