Healthcare Provider Details

I. General information

NPI: 1720656549
Provider Name (Legal Business Name): JA'NETTE LEE MARIE BOWDEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 RESORT WAY
ELLSWORTH ME
04605-1717
US

IV. Provider business mailing address

191 TOWN FARM RD
BUCKSPORT ME
04416-4438
US

V. Phone/Fax

Practice location:
  • Phone: 207-664-7780
  • Fax:
Mailing address:
  • Phone: 207-664-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP211263
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: