Provider Demographics
NPI:1538592225
Name:SMITH BOWEN, MARY E (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:SMITH BOWEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:P.O. BOX 273
Mailing Address - Street 2:
Mailing Address - City:WASSAIC
Mailing Address - State:NY
Mailing Address - Zip Code:12592
Mailing Address - Country:US
Mailing Address - Phone:845-309-8278
Mailing Address - Fax:
Practice Address - Street 1:46 MAPLE ST,
Practice Address - Street 2:THE KENT
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757
Practice Address - Country:US
Practice Address - Phone:860-927-5368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236394-1164W00000X
CT026865164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse