Provider Demographics
NPI:1972779791
Name:BOWLSON, ANGELA RENEE
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENEE
Last Name:BOWLSON
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 1:3837 VAILE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2210
Mailing Address - Country:US
Mailing Address - Phone:314-831-6400
Mailing Address - Fax:
Practice Address - Street 1:3837 VAILE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2210
Practice Address - Country:US
Practice Address - Phone:314-831-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO289733602Medicaid