Provider Demographics
NPI:1609607548
Name:BOWER, ANTOINETTE
Entity type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:
Last Name:BOWER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANTOINETTE
Other - Middle Name:
Other - Last Name:STASKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6175 HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8644
Mailing Address - Country:US
Mailing Address - Phone:440-226-4810
Mailing Address - Fax:
Practice Address - Street 1:1083 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1829
Practice Address - Country:US
Practice Address - Phone:440-358-7370
Practice Address - Fax:440-358-7373
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health