Provider Demographics
NPI:1750637922
Name:BOWLER, KEVIN GERARD (RN)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:GERARD
Last Name:BOWLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1231
Mailing Address - Country:US
Mailing Address - Phone:516-705-4466
Mailing Address - Fax:516-705-4466
Practice Address - Street 1:5 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1231
Practice Address - Country:US
Practice Address - Phone:516-705-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY564584163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management