Provider Demographics
NPI:1770567281
Name:BOWERMAN, JULIE (CNM)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BOWERMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HAZARD AVE
Mailing Address - Street 2:BLDG 3, UNIT 10
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4585
Mailing Address - Country:US
Mailing Address - Phone:860-763-4337
Mailing Address - Fax:860-763-6458
Practice Address - Street 1:139 HAZARD AVE
Practice Address - Street 2:BLDG 3, UNIT 10
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4585
Practice Address - Country:US
Practice Address - Phone:860-763-4337
Practice Address - Fax:860-763-6458
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000219176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q27367Medicare UPIN