Healthcare Provider Details

I. General information

NPI: 1114237468
Provider Name (Legal Business Name): MRS. MADELEINE BOWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 SHUFFIELD DR
LITTLE ROCK AR
72205-7100
US

IV. Provider business mailing address

20480 MARILYN DR
HENSLEY AR
72065-7700
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-9300
  • Fax:
Mailing address:
  • Phone: 501-888-2265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: