Healthcare Provider Details

I. General information

NPI: 1649458829
Provider Name (Legal Business Name): ANDREW JOSEPH BOWMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2008
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 N LEBANON ST
LEBANON IN
46052-1476
US

IV. Provider business mailing address

1800 BEECHWOOD DR
LAFAYETTE IN
47905-4159
US

V. Phone/Fax

Practice location:
  • Phone: 765-485-8500
  • Fax: 765-485-8509
Mailing address:
  • Phone: 765-448-6509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71002461A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: