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NPI Code Detail

MEDICARE: LUCRETIA LYNN BOWEN ATC, CSCS

MEDICARE: LUCRETIA LYNN BOWEN ATC, CSCS
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
12255A2300XAthletic Trainer0324SD

General Provider Information

NPI Number : 1548909724
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCRETIA LYNN BOWEN ATC, CSCS
Provider Business Mailing Address
First Line : 1437 WILLARD ST
Second Line :
City : STURGIS
State : SD
Zip : 57785-1851
Country : US
Telephone Number : 605-490-7749
Fax Number :
Provider Business Practice Location Address
First Line : 2479 E COLORADO BLVD
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-3204
Country : US
Telephone Number : 605-490-7749
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2022
Last Update Date : 06/03/2022

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