Provider Demographics
NPI:1336812577
Name:BOWSER, NATHAN DWAIN LEO
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:DWAIN LEO
Last Name:BOWSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16224-7910
Mailing Address - Country:US
Mailing Address - Phone:814-221-3236
Mailing Address - Fax:
Practice Address - Street 1:823 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1124
Practice Address - Country:US
Practice Address - Phone:814-297-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional