Provider Demographics
NPI:1972276137
Name:BOWDEN, JENNIFER IRENE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:IRENE
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:IRENE
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:5230 CORGAN WAY APT 525
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-8827
Mailing Address - Country:US
Mailing Address - Phone:463-200-3335
Mailing Address - Fax:
Practice Address - Street 1:5230 CORGAN WAY APT 525
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-8827
Practice Address - Country:US
Practice Address - Phone:463-200-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28207543A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28207543AOtherRN