Provider Demographics
NPI:1982079828
Name:BOWEN, BRIDGET L (LPN)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:L
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1405
Mailing Address - Country:US
Mailing Address - Phone:631-413-5441
Mailing Address - Fax:
Practice Address - Street 1:25 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1405
Practice Address - Country:US
Practice Address - Phone:631-413-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323541-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse