Healthcare Provider Details

I. General information

NPI: 1891279956
Provider Name (Legal Business Name): JACARMA CRYSTAL BOWMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACARMA CRYSTAL BOWMAN NP

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 PARCHMENT DR SE
GRAND RAPIDS MI
49546-2303
US

IV. Provider business mailing address

847 PARCHMENT DR SE
GRAND RAPIDS MI
49546-2303
US

V. Phone/Fax

Practice location:
  • Phone: 616-710-7811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704245798
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: