Healthcare Provider Details

I. General information

NPI: 1790744662
Provider Name (Legal Business Name): MARY L BOWEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAPLE ST W
HAMPTON SC
29924-3238
US

IV. Provider business mailing address

201 SIGMA DR STE 100
SUMMERVILLE SC
29486-7722
US

V. Phone/Fax

Practice location:
  • Phone: 803-943-3813
  • Fax: 803-943-5971
Mailing address:
  • Phone: 803-943-3813
  • Fax: 803-943-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1833
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: