MEDICARE: MS. NANCY LYNN BOWDEN NP, CNM

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	F360043-1	NY
2	367A00000X	Advanced Practice Midwife	F000697-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225193410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY LYNN BOWDEN NP, CNM

Provider Business Mailing Address
First Line	:	PO BOX 1559
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-0989
Country	:	US
Telephone Number	:	631-929-3305
Fax Number	:

Provider Business Practice Location Address
First Line	:	4875 SUNRISE HWY
Second Line	:	SUITE 200
City	:	BOHEMIA
State	:	NY
Zip	:	11716-4630
Country	:	US
Telephone Number	:	631-444-4686
Fax Number	:	631-444-4622

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	11/22/2014

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