Provider Demographics
NPI:1639187396
Name:BOWERSOX, PAULA R (CRNA)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:R
Last Name:BOWERSOX
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:R
Other - Last Name:BOWERSOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16669 DYSON HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-3938
Mailing Address - Country:US
Mailing Address - Phone:402-250-9895
Mailing Address - Fax:
Practice Address - Street 1:8901 INDIAN HILLS DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4029
Practice Address - Country:US
Practice Address - Phone:402-934-1612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100933367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE279659Medicare ID - Type Unspecified