Provider Demographics
NPI:1770857542
Name:BOWERS, DAVID JAMES (CRNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:BOWERS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 RAYLOC DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21750-1518
Mailing Address - Country:US
Mailing Address - Phone:301-678-5187
Mailing Address - Fax:301-678-5797
Practice Address - Street 1:261 BERKMORE PL
Practice Address - Street 2:SUITE 1A
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-6247
Practice Address - Country:US
Practice Address - Phone:304-258-5790
Practice Address - Fax:304-258-3745
Is Sole Proprietor?:No
Enumeration Date:2012-02-26
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR162950363LF0000X
WVAPRN62872-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV511021OtherMEDICARE FQHC