Healthcare Provider Details

I. General information

NPI: 1568554954
Provider Name (Legal Business Name): HEATHER J BOWKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER J MCGARY APRN

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 WILSON STREET
BREWER ME
04412-1003
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 207-989-1567
  • Fax: 207-989-2287
Mailing address:
  • Phone: 207-945-5247
  • Fax: 207-047-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR037544
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP081139
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: