Provider Demographics
NPI:1972195378
Name:BOWMAN, DAWN DIANE
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:DIANE
Last Name:BOWMAN
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 1:8260 W COVINGTON GETTYSBURG RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45318-1106
Mailing Address - Country:US
Mailing Address - Phone:937-418-9540
Mailing Address - Fax:
Practice Address - Street 1:8260 W COVINGTON GETTYSBURG RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:OH
Practice Address - Zip Code:45318-1106
Practice Address - Country:US
Practice Address - Phone:937-418-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0159572251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0159572Medicaid