Provider Demographics
NPI:1922298637
Name:BOWENS, BRENDA KAYE (RAS)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:KAYE
Last Name:BOWENS
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5049
Mailing Address - Country:US
Mailing Address - Phone:707-644-2577
Mailing Address - Fax:707-644-5501
Practice Address - Street 1:126 OHIO ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5049
Practice Address - Country:US
Practice Address - Phone:707-644-2577
Practice Address - Fax:707-644-5501
Is Sole Proprietor?:No
Enumeration Date:2007-07-29
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator