Provider Demographics
NPI:1063520047
Name:BOWEN, GAYLE M (ARNP)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:M
Last Name:BOWEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27 LOWELL ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1646
Mailing Address - Country:US
Mailing Address - Phone:603-622-5951
Mailing Address - Fax:603-622-6028
Practice Address - Street 1:27 LOWELL ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1646
Practice Address - Country:US
Practice Address - Phone:603-622-5951
Practice Address - Fax:603-622-6028
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0157282308363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30341010Medicaid
NH30341010Medicaid
NHP12177Medicare UPIN