Provider Demographics
NPI:1831498914
Name:BOWLBY, CHRISTAL M
Entity Type:Individual
Prefix:MS
First Name:CHRISTAL
Middle Name:M
Last Name:BOWLBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTAL
Other - Middle Name:M
Other - Last Name:FREER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-0553
Mailing Address - Country:US
Mailing Address - Phone:801-860-4622
Mailing Address - Fax:
Practice Address - Street 1:5965 S 900 E
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1720
Practice Address - Country:US
Practice Address - Phone:801-263-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker