Healthcare Provider Details

I. General information

NPI: 1154879872
Provider Name (Legal Business Name): LISA ANN BOWERS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 10/30/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402
APO AE
09180-0000
US

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-1454
  • Fax:
Mailing address:
  • Phone: 314-590-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR12627600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00939900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ00939900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: