Healthcare Provider Details

I. General information

NPI: 1447290689
Provider Name (Legal Business Name): JANICE BOWKER A.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 NORTH ST
WALTON NY
13856-1218
US

IV. Provider business mailing address

PO BOX 725
COOPERSTOWN NY
13326-0725
US

V. Phone/Fax

Practice location:
  • Phone: 607-865-6541
  • Fax: 607-865-1964
Mailing address:
  • Phone: 607-865-6541
  • Fax: 607-865-9164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300042
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: