Provider Demographics
NPI:1083300636
Name:BOWMAN, SHELBY SUE (NP)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:SUE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14176 S WEMBLEY CIR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1307
Mailing Address - Country:US
Mailing Address - Phone:801-413-6307
Mailing Address - Fax:
Practice Address - Street 1:14176 S WEMBLEY CIR
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-1307
Practice Address - Country:US
Practice Address - Phone:801-413-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11305254-4405363L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner