Provider Demographics
NPI:1982212072
Name:BOWER-NELSON, ALEXANDRIA (PA)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:
Last Name:BOWER-NELSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6428 E S AVE
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-9475
Mailing Address - Country:US
Mailing Address - Phone:231-342-8729
Mailing Address - Fax:
Practice Address - Street 1:6400 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9255
Practice Address - Country:US
Practice Address - Phone:231-342-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009946TMP20363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical