Provider Demographics
NPI:1144531690
Name:BOWEN, MARJORIE G (CRNP)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:G
Last Name:BOWEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-3049
Mailing Address - Country:US
Mailing Address - Phone:856-885-4708
Mailing Address - Fax:
Practice Address - Street 1:1433 RAINER RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-1939
Practice Address - Country:US
Practice Address - Phone:610-357-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN315184L163W00000X
PATP006357C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse