Healthcare Provider Details

I. General information

NPI: 1811179344
Provider Name (Legal Business Name): ERIC R BOWEN APNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E ENTERPRISE AVE
APPLETON WI
54913-7862
US

IV. Provider business mailing address

2105 E. ENTERPRISE AVE. SUITE 111
APPLETON WI
54913-7862
US

V. Phone/Fax

Practice location:
  • Phone: 920-560-1000
  • Fax: 920-731-6732
Mailing address:
  • Phone: 920-731-6611
  • Fax: 920-731-6732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number6846-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: