MEDICARE: SALLY BOWEN FNP, APRN, AAHIVS

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	363LF0000X	Family Nurse Practitioner	128982634405	UT
2	163W00000X	Registered Nurse	RN.1622426	CO
3	363LF0000X	Family Nurse Practitioner	APN.0995377-NP	CO

General Provider Information

NPI Number	:	1285256453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY BOWEN FNP, APRN, AAHIVS

Provider Business Mailing Address
First Line	:	150 S 1000 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1443
Country	:	US
Telephone Number	:	801-487-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 S 1000 E STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1496
Country	:	US
Telephone Number	:	801-487-2323
Fax Number	:

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

Provider Enumeration Date	:	05/11/2020
Last Update Date	:	07/20/2023

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