Provider Demographics
NPI:1710218920
Name:BOWMAN, JENIFER A (RD)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:A
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:SUITES 100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3400
Practice Address - Country:US
Practice Address - Phone:970-221-1000
Practice Address - Fax:970-297-6860
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
803216133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA106623Medicare PIN