Healthcare Provider Details

I. General information

NPI: 1063494672
Provider Name (Legal Business Name): JOHN MARK BLOWEN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MARK AVE
STRATHAM NH
03885-2221
US

IV. Provider business mailing address

3 MARK AVE
STRATHAM NH
03885-2221
US

V. Phone/Fax

Practice location:
  • Phone: 603-852-0513
  • Fax:
Mailing address:
  • Phone: 603-852-0513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0297872303
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP81765
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: