MEDICARE: MRS. MARY ROSALIND THORNTON-BOWMER APRN-BC, CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN516639L	PA
2	363LF0000X	Family Nurse Practitioner	SP009389	PA

General Provider Information

NPI Number	:	1184747776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ROSALIND THORNTON-BOWMER APRN-BC, CRNP

Provider Business Mailing Address
First Line	:	4700 WISSAHICKON AVE
Second Line	:	SUITE 118
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-4248
Country	:	US
Telephone Number	:	267-597-3600
Fax Number	:	267-597-3622

Provider Business Practice Location Address
First Line	:	2602 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1301
Country	:	US
Telephone Number	:	267-619-7778
Fax Number	:	215-318-2219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	05/19/2026

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