Basic Information
| Provider Information | |||||||||
| NPI: | 1619346780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWERS | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RN, MSN, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2605 WEST BAYSHORE DR. | ||||||||
| Address2: | |||||||||
| City: | PESHAWBESTOWN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2315347200 | ||||||||
| FaxNumber: | 2315347460 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 N. STALLMAN RD | ||||||||
| Address2: | |||||||||
| City: | SUTTONS BAY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3215347481 | ||||||||
| FaxNumber: | 2315347460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2015 | ||||||||
| LastUpdateDate: | 09/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | 4704170807 | MI | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.