Healthcare Provider Details

I. General information

NPI: 1194780239
Provider Name (Legal Business Name): GILES BOWMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOSPITAL DR
LOGAN WV
25601-3452
US

IV. Provider business mailing address

20 HOSPITAL DR
LOGAN WV
25601-3452
US

V. Phone/Fax

Practice location:
  • Phone: 304-831-1138
  • Fax: 304-831-1267
Mailing address:
  • Phone: 304-831-1138
  • Fax: 304-831-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number44138
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: