Provider Demographics
NPI:1962487132
Name:BOW, EILEEN ANNE (ARNP-FP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:ANNE
Last Name:BOW
Suffix:
Gender:F
Credentials:ARNP-FP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:ANNE
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0016
Mailing Address - Country:US
Mailing Address - Phone:509-526-0826
Mailing Address - Fax:
Practice Address - Street 1:77 WAINWRIGHT DR
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3975
Practice Address - Country:US
Practice Address - Phone:509-525-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP43362Medicare UPIN
WA8854213Medicare ID - Type Unspecified