Provider Demographics
NPI:1881956209
Name:BOWLIN, JOAN MARIE MASON (NP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE MASON
Last Name:BOWLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:STE 290
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2111
Mailing Address - Country:US
Mailing Address - Phone:952-914-1720
Mailing Address - Fax:
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:STE 290
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2111
Practice Address - Country:US
Practice Address - Phone:952-914-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR108944-4363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology