Provider Demographics
NPI:1801081146
Name:BOWE-SHULMAN, DORENE (LICAC)
Entity type:Individual
Prefix:
First Name:DORENE
Middle Name:
Last Name:BOWE-SHULMAN
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:DORENE
Other - Middle Name:
Other - Last Name:SHULMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 HENNESSEY DR
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3613
Mailing Address - Country:US
Mailing Address - Phone:978-621-4828
Mailing Address - Fax:
Practice Address - Street 1:4 HENNESSEY DR
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3613
Practice Address - Country:US
Practice Address - Phone:978-621-4828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228826171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist