Provider Demographics
NPI:1699925206
Name:BOWEN PASHKOW, MISTY RENEE
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:RENEE
Last Name:BOWEN PASHKOW
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 1:23 LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701
Mailing Address - Country:US
Mailing Address - Phone:814-362-6261
Mailing Address - Fax:
Practice Address - Street 1:5485 NICHOLS RUN
Practice Address - Street 2:
Practice Address - City:LIMESTONE
Practice Address - State:NY
Practice Address - Zip Code:14753-9774
Practice Address - Country:US
Practice Address - Phone:716-925-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288942-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse