Provider Demographics
NPI:1316353550
Name:BOWMAN, MEGAN KIMMERLE (LLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KIMMERLE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 36TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2809
Mailing Address - Country:US
Mailing Address - Phone:616-726-1942
Mailing Address - Fax:616-945-3541
Practice Address - Street 1:3333 36TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2809
Practice Address - Country:US
Practice Address - Phone:616-726-1942
Practice Address - Fax:616-945-3541
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015418171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator