Provider Demographics
NPI:1861831687
Name:BOWMAN, JODIE MARIE
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:MARIE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22310 QUAIL RUN WAY
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3119
Mailing Address - Country:US
Mailing Address - Phone:720-315-5865
Mailing Address - Fax:
Practice Address - Street 1:22310 QUAIL RUN WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3119
Practice Address - Country:US
Practice Address - Phone:720-315-5865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22235761Medicaid