Provider Demographics
NPI:1447290689
Name:BOWKER, JANICE (ANP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:BOWKER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-0725
Mailing Address - Country:US
Mailing Address - Phone:607-865-6541
Mailing Address - Fax:607-865-9164
Practice Address - Street 1:130 NORTH ST
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1218
Practice Address - Country:US
Practice Address - Phone:607-865-6541
Practice Address - Fax:607-865-1964
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300042363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02282066Medicaid
NYR58361Medicare UPIN
NY02282066Medicaid