Healthcare Provider Details

I. General information

NPI: 1649330762
Provider Name (Legal Business Name): TRACEY ANN BOWMAN MSN CNM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 PENNACOOK ST
MANCHESTER NH
03104-3554
US

IV. Provider business mailing address

784 HERCULES DR STE 110
COLCHESTER VT
05446-8049
US

V. Phone/Fax

Practice location:
  • Phone: 603-669-7321
  • Fax: 603-621-0097
Mailing address:
  • Phone: 802-448-9719
  • Fax: 802-660-9438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number03257721
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0325772301
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number101.0105155
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: