Provider Demographics
NPI:1710996699
Name:BOWEN, NANETTE A (PA-C)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:A
Last Name:BOWEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 HOOKELE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3532
Mailing Address - Country:US
Mailing Address - Phone:808-871-8878
Mailing Address - Fax:808-871-8867
Practice Address - Street 1:89 HOOKELE ST STE 103
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3532
Practice Address - Country:US
Practice Address - Phone:808-871-8878
Practice Address - Fax:808-871-8867
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002933363A00000X
HIAMD-905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S87452Medicare UPIN
N78710004Medicare ID - Type Unspecified
MIN38550047Medicare ID - Type Unspecified