Healthcare Provider Details

I. General information

NPI: 1609024272
Provider Name (Legal Business Name): STEPHANIE VINING BOWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 POPLAR AVE
MEMPHIS TN
38119-3816
US

IV. Provider business mailing address

5625 POPLAR AVE
MEMPHIS TN
38119-3816
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-0147
  • Fax: 901-763-4332
Mailing address:
  • Phone: 901-761-0147
  • Fax: 901-763-4332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0000001256
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: