Basic Information
| Provider Information | |||||||||
| NPI: | 1861558504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOHLEN | ||||||||
| FirstName: | ROWYNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ADULT NP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BOHLEN | ||||||||
| OtherFirstName: | ROWYNA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7 STUVESANT CIRCLE WEST | ||||||||
| Address2: | |||||||||
| City: | E SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314283910 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | STONY BROOK UNIVERSITY HOSPITAL | ||||||||
| Address2: | HSC T-17-040, NICOLLS RD | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117901179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314443655 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 303310 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | F303310 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.