Provider Demographics
NPI:1790067619
Name:BOWMAN, MELISSA R (PA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:235 WEALTHY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5247
Mailing Address - Country:US
Mailing Address - Phone:616-840-8000
Mailing Address - Fax:616-840-9642
Practice Address - Street 1:235 WEALTHY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5247
Practice Address - Country:US
Practice Address - Phone:616-840-8000
Practice Address - Fax:616-840-9642
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2025-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant