Provider Demographics
NPI:1215756622
Name:BOWMAN, MCKENZI
Entity type:Individual
Prefix:
First Name:MCKENZI
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 MCKINLEY AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-3066
Mailing Address - Country:US
Mailing Address - Phone:937-977-3080
Mailing Address - Fax:
Practice Address - Street 1:950 MCKINLEY AVE APT 3B
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-3066
Practice Address - Country:US
Practice Address - Phone:937-977-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602252620221163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant