Provider Demographics
NPI:1801124698
Name:BOWEN, JEANINE GABRELE (CRNA)
Entity type:Individual
Prefix:MS
First Name:JEANINE
Middle Name:GABRELE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-1115
Mailing Address - Country:US
Mailing Address - Phone:202-538-6088
Mailing Address - Fax:
Practice Address - Street 1:368 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-1115
Practice Address - Country:US
Practice Address - Phone:202-538-6088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2010-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704223851163W00000X
NY615771163W00000X
PARN582597163W00000X
DCRN966608163W00000X
MDR156163163W00000X
CT12.004275367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse