Provider Demographics
NPI:1265202584
Name:DIANA J. BOWEN, LLC
Entity type:Organization
Organization Name:DIANA J. BOWEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-877-4931
Mailing Address - Street 1:421 NECK RD
Mailing Address - Street 2:421 NECK ROAD
Mailing Address - City:SOUTH CHINA
Mailing Address - State:ME
Mailing Address - Zip Code:04358
Mailing Address - Country:US
Mailing Address - Phone:207-877-4931
Mailing Address - Fax:
Practice Address - Street 1:421 NECK RD
Practice Address - Street 2:421 NECK ROAD
Practice Address - City:SOUTH CHINA
Practice Address - State:ME
Practice Address - Zip Code:04358
Practice Address - Country:US
Practice Address - Phone:207-877-4931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health