Healthcare Provider Details

I. General information

NPI: 1366858730
Provider Name (Legal Business Name): MARIANNE BOWLING A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CIRCLE OF HOPE DR ROOM 2275
SALT LAKE CITY UT
84112-5550
US

IV. Provider business mailing address

2000 CIRCLE OF HOPE DR ROOM 2275
SALT LAKE CITY UT
84112-5550
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-4479
  • Fax: 801-581-6470
Mailing address:
  • Phone: 801-587-4479
  • Fax: 801-581-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7299594-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: