Basic Information
| Provider Information | |||||||||
| NPI: | 1417046566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWMAN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133900 | ||||||||
| FaxNumber: | 5179133901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133900 | ||||||||
| FaxNumber: | 5179133901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/19/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704118158 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0N55170003 | 01 | MI | MEDICARE PLUS BLUE | OTHER | 1059828 | 01 | MI | MCLAREN HEALTH PLAN-COMMERCIAL | OTHER | 1059828 | 01 | MI | MCLAREN HEALTH PLAN-MEDICAID | OTHER | 1059828 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER | 9507249 | 01 | MI | AETNA | OTHER |