Healthcare Provider Details

I. General information

NPI: 1245564434
Provider Name (Legal Business Name): BRENT V BOWLES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 S MILLENIUM WAY STE 100
MERIDIAN ID
83642-5036
US

IV. Provider business mailing address

1501 S MEADOW RD
SPRINGVILLE UT
84663-6008
US

V. Phone/Fax

Practice location:
  • Phone: 208-445-2456
  • Fax:
Mailing address:
  • Phone: 801-369-5435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA-884A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number281060-4406
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number30952.1190
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: