Healthcare Provider Details

I. General information

NPI: 1356447924
Provider Name (Legal Business Name): JENNIFER BZOWY ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 NW STEWART PKWY SUITE 240
ROSEBURG OR
97471-1516
US

IV. Provider business mailing address

PO BOX 568
WINCHESTER OR
97495-0568
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-4427
  • Fax: 541-677-6522
Mailing address:
  • Phone: 541-677-4427
  • Fax: 541-677-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number201603200NPPP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: