Provider Demographics
NPI:1790744662
Name:BOWEN, MARY L (APRN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:BOWEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:201 SIGM DRIVE #100
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7722
Mailing Address - Country:US
Mailing Address - Phone:803-943-3813
Mailing Address - Fax:803-943-5971
Practice Address - Street 1:300 MAPLE ST W
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-3238
Practice Address - Country:US
Practice Address - Phone:803-943-3813
Practice Address - Fax:803-943-5971
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCF1833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0734Medicaid
SCP01173874OtherRR-MEDICARE
SCP97325Medicare UPIN
SCP01173874OtherRR-MEDICARE
SCP973258798Medicare PIN