Healthcare Provider Details

I. General information

NPI: 1114971934
Provider Name (Legal Business Name): SHAWNNA MARIE BOWMAN L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 N 15TH ST
SEBRING OH
44672-1310
US

IV. Provider business mailing address

438 N 15TH ST
SEBRING OH
44672-1310
US

V. Phone/Fax

Practice location:
  • Phone: 330-206-2144
  • Fax:
Mailing address:
  • Phone: 330-206-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN095958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: