=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326486606
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RODNEY DION BOWMAN LPN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2013
-----------------------------------------------------
Last Update Date | 06/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2253 TRI COUNTY RD
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45697-0456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-728-7843
-----------------------------------------------------
Fax | 937-695-0073
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 456
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45697-0456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-728-7843
-----------------------------------------------------
Fax | 937-695-0073
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN.143234-M-IV
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------