Healthcare Provider Details

I. General information

NPI: 1346832334
Provider Name (Legal Business Name): GREGORY LYNN BOWMAN APRN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1450
CHICAGO IL
60611-3947
US

IV. Provider business mailing address

259 E ERIE ST STE 1450
CHICAGO IL
60611-3947
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7746
  • Fax: 312-694-6387
Mailing address:
  • Phone: 312-695-7746
  • Fax: 312-694-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027767
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209027767
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: