Provider Demographics
NPI:1598474942
Name:MOWRY, JAMIE GLEE (APNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:GLEE
Last Name:MOWRY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53536-1152
Mailing Address - Country:US
Mailing Address - Phone:608-882-5170
Mailing Address - Fax:608-882-6532
Practice Address - Street 1:10 N WATER ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53536-1152
Practice Address - Country:US
Practice Address - Phone:608-882-5170
Practice Address - Fax:608-882-6532
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI157421363LF0000X
WI13399363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1598474942Medicaid