=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316876303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI NICOLE BOWLIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2026
-----------------------------------------------------
Last Update Date | 06/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 WALL ST
-----------------------------------------------------
City | POWDERSVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29673-6754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-269-7950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 N MAIN ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29609-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-236-7677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 270183
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------