1972276137 NPI number — JENNIFER IRENE BOWDEN RN, BSN

Table of content: JENNIFER IRENE BOWDEN RN, BSN (NPI 1972276137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972276137 NPI number — JENNIFER IRENE BOWDEN RN, BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWDEN
Provider First Name:
JENNIFER
Provider Middle Name:
IRENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAUGHERTY
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
IRENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972276137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5230 CORGAN WAY APT 525
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46241-8827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
463-200-3335
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5230 CORGAN WAY APT 525
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46241-8827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
463-200-3335
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  28207543A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28207543A . This is a "RN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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