Provider Demographics
NPI:1780360065
Name:BOWMAN, SHANNA HAYDU (NP)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:HAYDU
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:SHANNA
Other - Middle Name:BETH
Other - Last Name:HAYDU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9071 E MISSISSIPPI AVE APT 32E
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2062
Mailing Address - Country:US
Mailing Address - Phone:860-488-0788
Mailing Address - Fax:
Practice Address - Street 1:14221 E 4TH AVE # 2-126
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8735
Practice Address - Country:US
Practice Address - Phone:720-507-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998803-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily