Provider Demographics
NPI:1295873263
Name:BOWEN, ANITA R (RNC, WHNP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:BOWEN
Suffix:
Gender:F
Credentials:RNC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2502
Mailing Address - Country:US
Mailing Address - Phone:573-426-6410
Mailing Address - Fax:
Practice Address - Street 1:1032 KINGSHIGHWAY ST STE B
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2921
Practice Address - Country:US
Practice Address - Phone:573-364-1509
Practice Address - Fax:573-364-6520
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO150629363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health