MEDICARE: EILEEN BOWIE CRNP

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	363A00000X	Physician Assistant	SP005765C	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP005765C	OTHER	PA	LICENSE #

General Provider Information

NPI Number	:	1548353600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN BOWIE CRNP

Provider Business Mailing Address
First Line	:	1703 S BROAD ST
Second Line	:	STE. 300 ATTN: ANGELA MIDDLETON
City	:	PHILA
State	:	PA
Zip	:	19148-1536
Country	:	US
Telephone Number	:	215-462-7100
Fax Number	:	215-463-3820

Provider Business Practice Location Address
First Line	:	1703 S BROAD ST
Second Line	:	STE. 300
City	:	PHILA
State	:	PA
Zip	:	19148-1536
Country	:	US
Telephone Number	:	215-462-7100
Fax Number	:	215-463-3820

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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