Provider Demographics
NPI:1124454475
Name:BOWEN, MELISSA ROCHELLE (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROCHELLE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 B ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-3532
Mailing Address - Country:US
Mailing Address - Phone:402-202-2723
Mailing Address - Fax:
Practice Address - Street 1:4741 N 26TH ST
Practice Address - Street 2:STE D
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4707
Practice Address - Country:US
Practice Address - Phone:402-474-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111585363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology