Provider Demographics
NPI:1902144579
Name:BOWEN, JACQUELYN M (RN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:M
Last Name:BOWEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 SW SPOKANE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3234
Mailing Address - Country:US
Mailing Address - Phone:206-252-9700
Mailing Address - Fax:206-252-9701
Practice Address - Street 1:5000 SW SPOKANE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3234
Practice Address - Country:US
Practice Address - Phone:206-252-9700
Practice Address - Fax:206-252-9701
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00117875163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse