Healthcare Provider Details

I. General information

NPI: 1497098339
Provider Name (Legal Business Name): TONYA A BOWZER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONYA A TABOR NP

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COMMERCE DR
NORTHBRIDGE MA
01534-1415
US

IV. Provider business mailing address

9 INDUSTRIAL RD STE 5
MILFORD MA
01757-3736
US

V. Phone/Fax

Practice location:
  • Phone: 508-372-3510
  • Fax: 508-234-2627
Mailing address:
  • Phone: 508-473-1480
  • Fax: 508-473-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN284920
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN284920
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: