Provider Demographics
NPI:1861558504
Name:BOHLEN, ROWYNA (ADULT NP)
Entity type:Individual
Prefix:MS
First Name:ROWYNA
Middle Name:
Last Name:BOHLEN
Suffix:
Gender:F
Credentials:ADULT NP
Other - Prefix:
Other - First Name:ROWYNA
Other - Middle Name:
Other - Last Name:BOHLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7 STUVESANT CIRCLE WEST
Mailing Address - Street 2:
Mailing Address - City:E SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733
Mailing Address - Country:US
Mailing Address - Phone:631-428-3910
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:HSC T-17-040, NICOLLS RD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1179
Practice Address - Country:US
Practice Address - Phone:631-444-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303310363LA2200X
NYF303310363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health