=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265683130
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANNE BOWERS F.N.P.-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2008
-----------------------------------------------------
Last Update Date | 09/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3801 WILLIAM D TATE AVE STE 840
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-8759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-310-3772
-----------------------------------------------------
Fax | 817-310-3950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3801 WILLIAM D TATE AVE STE 840
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-8759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-310-3772
-----------------------------------------------------
Fax | 817-310-3950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 655663
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------