Provider Demographics
NPI:1992217509
Name:BOWEN, AMBY BOWEN (RN CCM)
Entity Type:Individual
Prefix:
First Name:AMBY
Middle Name:BOWEN
Last Name:BOWEN
Suffix:
Gender:F
Credentials:RN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 BRIDGEPORT WAY W
Mailing Address - Street 2:BOX A-170
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-7521
Mailing Address - Country:US
Mailing Address - Phone:253-722-3430
Mailing Address - Fax:833-224-3844
Practice Address - Street 1:3800 BRIDGEPORT WAY W
Practice Address - Street 2:BOX A-170
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-7521
Practice Address - Country:US
Practice Address - Phone:253-722-3430
Practice Address - Fax:833-224-3844
Is Sole Proprietor?:No
Enumeration Date:2017-11-04
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4207529163WC0400X
WARN60051233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management