Provider Demographics
NPI:1770869406
Name:BOWMAN, MARY ELIZABETH (ACNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 PARK PLACE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3314
Mailing Address - Country:US
Mailing Address - Phone:804-332-5950
Mailing Address - Fax:804-728-1086
Practice Address - Street 1:4212 PARK PLACE CT
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3314
Practice Address - Country:US
Practice Address - Phone:804-332-5950
Practice Address - Fax:804-728-1086
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169655363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care