MEDICARE: MRS. PAULA RENEE BOWEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LPN.111086.MEDS	OH

General Provider Information

NPI Number	:	1194668996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAULA RENEE BOWEN

Provider Business Mailing Address
First Line	:	1203 KENNISON AVE
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-1222
Country	:	US
Telephone Number	:	937-845-4480
Fax Number	:	937-845-5029

Provider Business Practice Location Address
First Line	:	1203 KENNISON AVE
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-1222
Country	:	US
Telephone Number	:	937-845-4480
Fax Number	:	937-845-5029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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