Provider Demographics
NPI:1053882043
Name:BOWERS, HEATHER (AGNP-BC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13839 CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:SUNFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48890-9784
Mailing Address - Country:US
Mailing Address - Phone:517-526-1050
Mailing Address - Fax:
Practice Address - Street 1:2901 STABLER ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3022
Practice Address - Country:US
Practice Address - Phone:517-272-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244429363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology