MEDICARE: TONI ANTOINETTE BOWMAN-BOLER RN

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	163W00000X	Registered Nurse	829502	NV
2	163WM0705X	Medical-Surgical Registered Nurse	829502	NV
3	163WP2201X	Ambulatory Care Registered Nurse	829502	NV

General Provider Information

NPI Number	:	1922978717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI ANTOINETTE BOWMAN-BOLER RN

Provider Business Mailing Address
First Line	:	6728 CHARGEHAND AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-3786
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6728 CHARGEHAND AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-3786
Country	:	US
Telephone Number	:	562-336-4693
Fax Number	:

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

Provider Enumeration Date	:	11/07/2025
Last Update Date	:	11/07/2025

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