MEDICARE: MS. LATOYA JOYCE BOWERS LVN

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	164X00000X	Licensed Vocational Nurse	1013702	TX

General Provider Information

NPI Number	:	1568066488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATOYA JOYCE BOWERS LVN

Provider Business Mailing Address
First Line	:	9149 BARBARO DR APT 7102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-1889
Country	:	US
Telephone Number	:	817-344-0471
Fax Number	:

Provider Business Practice Location Address
First Line	:	9149 BARBARO DR APT 7102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-1889
Country	:	US
Telephone Number	:	817-344-0471
Fax Number	:

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

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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