Provider Demographics
NPI:1780743583
Name:BOWMAN, MAUREEN WHOOLEY (CRNA)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:WHOOLEY
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:1214 RINCON MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2526
Mailing Address - Country:US
Mailing Address - Phone:707-539-5853
Mailing Address - Fax:707-539-5853
Practice Address - Street 1:401 BICENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2149
Practice Address - Country:US
Practice Address - Phone:707-571-4000
Practice Address - Fax:707-571-4000
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAX182490367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR21766Medicare UPIN