Healthcare Provider Details

I. General information

NPI: 1770567281
Provider Name (Legal Business Name): JULIE BOWERMAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 HAZARD AVE BLDG 3, UNIT 10
ENFIELD CT
06082-4585
US

IV. Provider business mailing address

139 HAZARD AVE BLDG 3, UNIT 10
ENFIELD CT
06082-4585
US

V. Phone/Fax

Practice location:
  • Phone: 860-763-4337
  • Fax: 860-763-6458
Mailing address:
  • Phone: 860-763-4337
  • Fax: 860-763-6458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number000219
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000219
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: