Provider Demographics
NPI:1295796688
Name:BOWLIN, STEPHANIE D (EDD, PA)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:D
Last Name:BOWLIN
Suffix:
Gender:F
Credentials:EDD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18064 CLARKE CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-8742
Mailing Address - Country:US
Mailing Address - Phone:909-208-7478
Mailing Address - Fax:
Practice Address - Street 1:191 E ALESSANDRO BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5095
Practice Address - Country:US
Practice Address - Phone:951-749-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA1142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant