Provider Demographics
NPI:1649277922
Name:BOWERS, JANIS (NP)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 W. ALMOSTA RANCH RD.
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7934
Mailing Address - Country:US
Mailing Address - Phone:928-777-0137
Mailing Address - Fax:
Practice Address - Street 1:907 AINSWORTH DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1607
Practice Address - Country:US
Practice Address - Phone:928-777-0070
Practice Address - Fax:928-445-7163
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN143483363LF0000X
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR262320Medicaid
OR262320Medicaid
R115124Medicare ID - Type Unspecified