Healthcare Provider Details

I. General information

NPI: 1548387053
Provider Name (Legal Business Name): JOANNE M BOWEN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 EUCLID AVE
BERWYN IL
60402-3864
US

IV. Provider business mailing address

3605 EUCLID AVE
BERWYN IL
60402-3864
US

V. Phone/Fax

Practice location:
  • Phone: 708-484-0347
  • Fax: 708-401-0446
Mailing address:
  • Phone: 708-484-0347
  • Fax: 708-401-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: