Provider Demographics
NPI:1063962165
Name:BOWERS, TANA (LPN)
Entity type:Individual
Prefix:
First Name:TANA
Middle Name:
Last Name:BOWERS
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 1:1220 MOUNT VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-1154
Mailing Address - Country:US
Mailing Address - Phone:423-435-4482
Mailing Address - Fax:
Practice Address - Street 1:350 DAWSON ST
Practice Address - Street 2:
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885-2420
Practice Address - Country:US
Practice Address - Phone:423-884-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27067164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse