Provider Demographics
NPI:1780275032
Name:BOWERS, JANE DARRAS
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:DARRAS
Last Name:BOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 CHAPLINE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3876
Mailing Address - Country:US
Mailing Address - Phone:304-232-7151
Mailing Address - Fax:304-232-6128
Practice Address - Street 1:2101 CHAPLINE ST STE 200
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3876
Practice Address - Country:US
Practice Address - Phone:304-232-7151
Practice Address - Fax:304-232-6128
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107781363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV46-2057899Medicaid