Healthcare Provider Details

I. General information

NPI: 1912103706
Provider Name (Legal Business Name): BOWER TAKE CARE HEALTH NEVADA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 W TROPICANA AVE
LAS VEGAS NV
89103
US

IV. Provider business mailing address

1901 E VOORHEES ST MS 640
DANVILLE IL
61834-4509
US

V. Phone/Fax

Practice location:
  • Phone: 855-925-4733
  • Fax:
Mailing address:
  • Phone: 855-925-4733
  • Fax: 217-709-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA BOWER
Title or Position: PRESIDENT
Credential:
Phone: 855-925-4733