Healthcare Provider Details

I. General information

NPI: 1114486024
Provider Name (Legal Business Name): VICTORIA BOWMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 08/20/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30762 STATE HIGHWAY 181
SPANISH FORT AL
36527-5672
US

IV. Provider business mailing address

307 STATE HWY 181
SPANISH FORT AL
36527
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-0732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-157700
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-157700
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: