Provider Demographics
NPI:1285891051
Name:BOUWER, PATRICIA (RN,MS,FNP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:BOUWER
Suffix:
Gender:F
Credentials:RN,MS,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 SPOONVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06260
Mailing Address - Country:US
Mailing Address - Phone:860-651-0344
Mailing Address - Fax:
Practice Address - Street 1:290 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1236
Practice Address - Country:US
Practice Address - Phone:860-652-3325
Practice Address - Fax:860-625-3330
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000983363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics