Healthcare Provider Details

I. General information

NPI: 1114397726
Provider Name (Legal Business Name): MRS. SHERRI BOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 DOROTHY ST NE
ALBUQUERQUE NM
87112-5549
US

IV. Provider business mailing address

1121 DOROTHY ST NE
ALBUQUERQUE NM
87112-5549
US

V. Phone/Fax

Practice location:
  • Phone: 505-301-9018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0176471
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0176081
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: