Provider Demographics
NPI:1649873209
Name:BOWMAN, ALEXA L (RD)
Entity type:Individual
Prefix:MRS
First Name:ALEXA
Middle Name:L
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:ALEXA
Other - Middle Name:L
Other - Last Name:WETHERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1403
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89446-1403
Mailing Address - Country:US
Mailing Address - Phone:775-741-9243
Mailing Address - Fax:
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1576
Practice Address - Country:US
Practice Address - Phone:775-982-3659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39838-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered