Provider Demographics
NPI:1124838321
Name:BOWCOCK, MADISON FAITH
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:FAITH
Last Name:BOWCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADDY
Other - Middle Name:
Other - Last Name:BOWCOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3116 MIDDLEBORO RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-9495
Mailing Address - Country:US
Mailing Address - Phone:513-641-8627
Mailing Address - Fax:
Practice Address - Street 1:3116 MIDDLEBORO RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-9495
Practice Address - Country:US
Practice Address - Phone:513-641-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602628260323376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide