Healthcare Provider Details

I. General information

NPI: 1528620101
Provider Name (Legal Business Name): LISA MARIE BOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 E WAHALLA LN
PHOENIX AZ
85050-7904
US

IV. Provider business mailing address

3330 E WAHALLA LN
PHOENIX AZ
85050-7904
US

V. Phone/Fax

Practice location:
  • Phone: 602-568-8506
  • Fax:
Mailing address:
  • Phone: 602-568-8506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: