Provider Demographics
NPI:1720473325
Name:BOWSER, VICKY (APN)
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:
Last Name:BOWSER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 DAVISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3332
Mailing Address - Country:US
Mailing Address - Phone:856-357-0231
Mailing Address - Fax:
Practice Address - Street 1:621 BEVERLY RANCOCAS RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3727
Practice Address - Country:US
Practice Address - Phone:609-877-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00537000363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics