Provider Demographics
NPI:1013743871
Name:BOWEN, SHEILA LOUISE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:LOUISE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W REPUBLIC RD STE A112
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5805
Mailing Address - Country:US
Mailing Address - Phone:417-350-8730
Mailing Address - Fax:
Practice Address - Street 1:600 W REPUBLIC RD STE A112
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5805
Practice Address - Country:US
Practice Address - Phone:417-350-8730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024036066363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health