Healthcare Provider Details

I. General information

NPI: 1285215988
Provider Name (Legal Business Name): LORETTA KAY BOWENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 PANTALEO DR
MODESTO CA
95355-9362
US

IV. Provider business mailing address

1701 PANTALEO DR
MODESTO CA
95355-9362
US

V. Phone/Fax

Practice location:
  • Phone: 209-326-5996
  • Fax:
Mailing address:
  • Phone: 209-326-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number462010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: