Provider Demographics
NPI:1962084194
Name:BOWMAN, ALICE MARY
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:MARY
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 1:5408 MERIDIAN AVE N APT 301
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6100
Mailing Address - Country:US
Mailing Address - Phone:206-819-6661
Mailing Address - Fax:
Practice Address - Street 1:6700 FORT DENT WAY STE 100
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2504
Practice Address - Country:US
Practice Address - Phone:206-337-6080
Practice Address - Fax:206-923-8089
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
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