Basic Information
| Provider Information | |||||||||
| NPI: | 1477912756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWSER | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22810 ROUTE 68 | ||||||||
| Address2: | |||||||||
| City: | CLARION | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162148512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245047601 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 FAIRFIELD DR | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163462130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146767600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2016 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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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 | 363L00000X | SP019999 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | RN622719 | PA | N | Nursing Service Providers | Registered Nurse |
No ID Information.