Provider Demographics
NPI:1932740164
Name:BOWEN, RHONDA
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 CANNON HILL RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:ME
Mailing Address - Zip Code:04667-3413
Mailing Address - Country:US
Mailing Address - Phone:207-853-2755
Mailing Address - Fax:
Practice Address - Street 1:270 CANNON HILL RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:ME
Practice Address - Zip Code:04667-3413
Practice Address - Country:US
Practice Address - Phone:207-853-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-29
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME995A22680Medicaid