Provider Demographics
NPI:1184931909
Name:BOWERS, STEPHANIE SMITH (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SMITH
Last Name:BOWERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WYCKOFF RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08827-2560
Mailing Address - Country:US
Mailing Address - Phone:908-763-0568
Mailing Address - Fax:
Practice Address - Street 1:9 WYCKOFF RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08827-2560
Practice Address - Country:US
Practice Address - Phone:908-763-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00632400363L00000X
IL209008324363LA2200X
NC206500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1184931909Medicaid
NCNCB569AMedicare PIN