Provider Demographics
NPI:1295809507
Name:BOWEN, LOU ANN (CRNA)
Entity type:Individual
Prefix:MRS
First Name:LOU
Middle Name:ANN
Last Name:BOWEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 6TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-0270
Mailing Address - Country:US
Mailing Address - Phone:304-442-4954
Mailing Address - Fax:304-442-1324
Practice Address - Street 1:401 6TH AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-0270
Practice Address - Country:US
Practice Address - Phone:304-442-1331
Practice Address - Fax:304-442-1324
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23413207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0066341000Medicaid
WV0066341000Medicaid
S30950Medicare UPIN