Healthcare Provider Details

I. General information

NPI: 1598220451
Provider Name (Legal Business Name): SERINA BOWEN RN, BSN, M.ED, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 4TH ST
FULLERTON NE
68638-3176
US

IV. Provider business mailing address

27867 WOODSIDE DR
COLUMBUS NE
68601-8978
US

V. Phone/Fax

Practice location:
  • Phone: 308-536-2431
  • Fax:
Mailing address:
  • Phone: 970-216-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number77976
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: