Basic Information
| Provider Information | |||||||||
| NPI: | 1295874568 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWMAN | ||||||||
| FirstName: | EARMON | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1962 COUNTY ROAD 384 | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356434255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563013340 | ||||||||
| FaxNumber: | 2563013443 | ||||||||
| Practice Location | |||||||||
| Address1: | 1874 BELTLINE RD SW | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356015514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563013340 | ||||||||
| FaxNumber: | 2563013443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1-040371 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1-040371 | 01 | AL | STATE LICENSE | OTHER | 41479 | 01 | AL | CRNA LICENSE | OTHER |