Provider Demographics
NPI:1649330762
Name:BOWMAN, TRACEY ANN (MSN CNM ARNP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANN
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MSN CNM ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 HERCULES DR
Mailing Address - Street 2:STE 110
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8049
Mailing Address - Country:US
Mailing Address - Phone:802-448-9719
Mailing Address - Fax:802-660-9438
Practice Address - Street 1:24 PENNACOOK ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3554
Practice Address - Country:US
Practice Address - Phone:603-669-7321
Practice Address - Fax:603-621-0097
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03257721363L00000X
NH0325772301367A00000X
VT101.0105155367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
58509OtherBCBS OF VERMONT
58510OtherWOMEN'S WAY MIDWIFERY
4007922Y0NH01OtherWOMEN'S WAY MIDWIFERY
AA11041OtherHARVARD PILGRIM WOMENS WA
7652101OtherCIGNA
AA48590OtherHARVARD PILGRIM
648836OtherTUFTS
NH30340425Medicaid
1243285OtherAETNA
4007922Y0NH05OtherANTHEM