Healthcare Provider Details

I. General information

NPI: 1427485432
Provider Name (Legal Business Name): PATRICIA ANN BOWMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 W SANETTA ST
NAMPA ID
83651-5047
US

IV. Provider business mailing address

1031 W SANETTA ST
NAMPA ID
83651-5047
US

V. Phone/Fax

Practice location:
  • Phone: 208-466-7443
  • Fax: 208-466-5058
Mailing address:
  • Phone: 208-466-7443
  • Fax: 208-466-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number27245
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: