Provider Demographics
NPI:1386317923
Name:BOWEN, SUSAN MARIE (PMHNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 N 74TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1051
Mailing Address - Country:US
Mailing Address - Phone:602-441-2778
Mailing Address - Fax:
Practice Address - Street 1:10450 N 74TH ST STE 160
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1051
Practice Address - Country:US
Practice Address - Phone:602-441-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN150408363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health