MEDICARE: MS. DESIREE BOWER

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	374U00000X	Home Health Aide	374U00000X	ME

General Provider Information

NPI Number	:	1922391168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DESIREE BOWER

Provider Business Mailing Address
First Line	:	PO BOX 691
Second Line	:
City	:	SOUTH CHINA
State	:	ME
Zip	:	04358-0691
Country	:	US
Telephone Number	:	386-986-7570
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 VILLAGE ST
Second Line	:
City	:	SOUTH CHINA
State	:	ME
Zip	:	04358-5242
Country	:	US
Telephone Number	:	386-986-7570
Fax Number	:

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

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	05/20/2011

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