Provider Demographics
NPI:1871182501
Name:BOWENS, JO ANN
Entity Type:Individual
Prefix:
First Name:JO ANN
Middle Name:
Last Name:BOWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 WANETA ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-7761
Mailing Address - Country:US
Mailing Address - Phone:513-571-6922
Mailing Address - Fax:
Practice Address - Street 1:2906 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6950
Practice Address - Country:US
Practice Address - Phone:513-423-7940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 253Z00000X, 374U00000X, 376K00000X
OH374U00000X, 376K00000X
OH372532171192376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH485147358Medicaid
OHPODA0000550Medicaid