Healthcare Provider Details

I. General information

NPI: 1225193410
Provider Name (Legal Business Name): NANCY LYNN BOWDEN NP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4875 SUNRISE HWY SUITE 200
BOHEMIA NY
11716-4630
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4686
  • Fax: 631-444-4622
Mailing address:
  • Phone: 631-929-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF360043-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000697-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierGP3003683
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: