Healthcare Provider Details

I. General information

NPI: 1518206572
Provider Name (Legal Business Name): LISA MARIE BOWLING CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE WILT

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
JB MDL NJ
08641-5312
US

IV. Provider business mailing address

3458 NEELY RD
JB MDL NJ
08641-5312
US

V. Phone/Fax

Practice location:
  • Phone: 609-754-9576
  • Fax: 609-754-9015
Mailing address:
  • Phone: 609-754-9576
  • Fax: 609-754-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NR19590800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: