Healthcare Provider Details

I. General information

NPI: 1053882043
Provider Name (Legal Business Name): HEATHER BOWERS AGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 STABLER ST
LANSING MI
48910-3022
US

IV. Provider business mailing address

13839 CHARLOTTE HWY
SUNFIELD MI
48890-9784
US

V. Phone/Fax

Practice location:
  • Phone: 517-272-1950
  • Fax:
Mailing address:
  • Phone: 517-526-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704244429
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: