Healthcare Provider Details

I. General information

NPI: 1609826866
Provider Name (Legal Business Name): MONIKA BOWDEN C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 HWY 190 E SERV RD
COVINGTON LA
70433-4960
US

IV. Provider business mailing address

321 WINDERMERE OAKS E
MADISONVILLE LA
70447
US

V. Phone/Fax

Practice location:
  • Phone: 985-809-1997
  • Fax: 985-809-1664
Mailing address:
  • Phone: 985-845-0093
  • Fax: 985-809-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number048165
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: