Provider Demographics
NPI:1174049464
Name:BOWEN, MICHELLE DENISE (LPN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENISE
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 1:46 PAERDEGAT 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4124
Mailing Address - Country:US
Mailing Address - Phone:917-789-9723
Mailing Address - Fax:
Practice Address - Street 1:46 PAERDEGAT 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4124
Practice Address - Country:US
Practice Address - Phone:917-789-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306784164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse