Healthcare Provider Details

I. General information

NPI: 1952668279
Provider Name (Legal Business Name): NICOLE CAROLYN BOWEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE CAROLYN DELBROCCO RN

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

1172 SILVER CREEK LN
ALABASTER AL
35007-7562
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-9480
  • Fax:
Mailing address:
  • Phone: 205-620-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number1-088736
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: