Provider Demographics
NPI:1053603662
Name:BOWER, PAMELA JEAN
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEAN
Last Name:BOWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 STATE HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:JELM
Mailing Address - State:WY
Mailing Address - Zip Code:82063-9224
Mailing Address - Country:US
Mailing Address - Phone:307-760-9519
Mailing Address - Fax:
Practice Address - Street 1:57 STATE HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:JELM
Practice Address - State:WY
Practice Address - Zip Code:82063-9224
Practice Address - Country:US
Practice Address - Phone:307-760-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-15
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No171M00000XOther Service ProvidersCase Manager/Care Coordinator