Healthcare Provider Details

I. General information

NPI: 1427645597
Provider Name (Legal Business Name): TIFFANY MARIE BOWSER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY MARIE MAGIERA

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E CULVER RD STE 102
KNOX IN
46534-2241
US

IV. Provider business mailing address

2022 KELLE DR
CHESTERTON IN
46304-8708
US

V. Phone/Fax

Practice location:
  • Phone: 574-772-7918
  • Fax: 574-772-0894
Mailing address:
  • Phone: 219-364-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010672A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: