Provider Demographics
NPI:1750662862
Name:BOWEN, COLLETT T (LPN)
Entity Type:Individual
Prefix:MS
First Name:COLLETT
Middle Name:T
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3486
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-0486
Mailing Address - Country:US
Mailing Address - Phone:845-309-5577
Mailing Address - Fax:
Practice Address - Street 1:22 MANITOU AVE APT 1
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2736
Practice Address - Country:US
Practice Address - Phone:845-309-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275320-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse