Healthcare Provider Details

I. General information

NPI: 1407031651
Provider Name (Legal Business Name): LORI BOWDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 MISSION AVE STE 3
CARMICHAEL CA
95608-2946
US

IV. Provider business mailing address

3441 MARYSVILLE BLVD
SACRAMENTO CA
95838-4512
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-6702
  • Fax: 916-563-7229
Mailing address:
  • Phone: 916-563-7230
  • Fax: 916-563-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP17930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: