Provider Demographics
NPI:1487264818
Name:BOWMAN, HOLLY (PA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-927-1756
Mailing Address - Fax:260-927-1772
Practice Address - Street 1:510 SMALTZ WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-0612
Practice Address - Country:US
Practice Address - Phone:260-927-1756
Practice Address - Fax:260-927-1772
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2022-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10003016A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant