Provider Demographics
NPI:1790030260
Name:BOWEN, MELISSA JEAN (RN MSN CNL)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:BOWEN
Suffix:
Gender:F
Credentials:RN MSN CNL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 FALLOW CT
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2261
Mailing Address - Country:US
Mailing Address - Phone:614-506-1665
Mailing Address - Fax:
Practice Address - Street 1:644 FALLOW CT
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2261
Practice Address - Country:US
Practice Address - Phone:614-506-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH236793163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health