Provider Demographics
NPI:1255770756
Name:JANET R BOWEN, LLC
Entity type:Organization
Organization Name:JANET R BOWEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:715-358-7727
Mailing Address - Street 1:PO BOX 754
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-0754
Mailing Address - Country:US
Mailing Address - Phone:715-358-7727
Mailing Address - Fax:715-358-7525
Practice Address - Street 1:1106 4TH AVE
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-9481
Practice Address - Country:US
Practice Address - Phone:715-358-7727
Practice Address - Fax:715-358-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57301-030261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43855700Medicaid
WI43855700Medicaid