MEDICARE: EILEEN ANNE BOW ARNP-FP

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	AP30006029	WA

General Provider Information

NPI Number	:	1962487132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN ANNE BOW ARNP-FP

Provider Business Mailing Address
First Line	:	PO BOX 671
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-0016
Country	:	US
Telephone Number	:	509-526-0826
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 WAINWRIGHT DR
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-3975
Country	:	US
Telephone Number	:	509-525-5200
Fax Number	:

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

Provider Enumeration Date	:	12/10/2005
Last Update Date	:	07/08/2007

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