Provider Demographics
NPI:1487297677
Name:BOWMAN, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
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 1:681 CIMARRON TRL
Mailing Address - Street 2:
Mailing Address - City:AULT
Mailing Address - State:CO
Mailing Address - Zip Code:80610-8908
Mailing Address - Country:US
Mailing Address - Phone:970-405-6325
Mailing Address - Fax:
Practice Address - Street 1:3400 W 16TH ST STE E
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6870
Practice Address - Country:US
Practice Address - Phone:970-352-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002025556124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist