Healthcare Provider Details

I. General information

NPI: 1912818204
Provider Name (Legal Business Name): EMILY BOWMAN RN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16967 W MARSHALL LN
SURPRISE AZ
85388-1523
US

IV. Provider business mailing address

16967 W MARSHALL LN
SURPRISE AZ
85388-1523
US

V. Phone/Fax

Practice location:
  • Phone: 623-633-5891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number315629
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: