Provider Demographics
NPI:1043032857
Name:BOWMAN, LESA (RN)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 NW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-6427
Mailing Address - Country:US
Mailing Address - Phone:405-413-5372
Mailing Address - Fax:
Practice Address - Street 1:4301 N CLASSEN BLVD STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-5031
Practice Address - Country:US
Practice Address - Phone:405-413-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95054611163W00000X
OKR0063297163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse