Provider Demographics
NPI:1295874568
Name:BOWMAN, EARMON WAYNE (CRNA)
Entity type:Individual
Prefix:
First Name:EARMON
Middle Name:WAYNE
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 COUNTY ROAD 384
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35643-4255
Mailing Address - Country:US
Mailing Address - Phone:256-301-3340
Mailing Address - Fax:256-301-3443
Practice Address - Street 1:1874 BELTLINE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5514
Practice Address - Country:US
Practice Address - Phone:256-301-3340
Practice Address - Fax:256-301-3443
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-040371367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-040371OtherSTATE LICENSE
AL41479OtherCRNA LICENSE