Provider Demographics
NPI:1790067619
Name:BOWMAN, MELISSA R (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:75 REMIT DR # 1122
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1122
Mailing Address - Country:US
Mailing Address - Phone:866-916-5259
Mailing Address - Fax:231-922-4030
Practice Address - Street 1:703 N MCEWAN ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1440
Practice Address - Country:US
Practice Address - Phone:866-916-5259
Practice Address - Fax:231-922-4030
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant