Provider Demographics
NPI:1366335879
Name:BOWEN-MORTLOCK, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BOWEN-MORTLOCK
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 1:11911 NW 34TH PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1235
Mailing Address - Country:US
Mailing Address - Phone:954-224-3217
Mailing Address - Fax:
Practice Address - Street 1:11911 NW 34TH PL
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-1235
Practice Address - Country:US
Practice Address - Phone:954-224-3217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9449444163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis