Provider Demographics
NPI:1053999672
Name:BOWMAN-DEFINO, ANDREA ROSE (RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ROSE
Last Name:BOWMAN-DEFINO
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MARTHA PL
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5222
Mailing Address - Country:US
Mailing Address - Phone:716-583-2676
Mailing Address - Fax:
Practice Address - Street 1:12234 ROUTE 39
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:NY
Practice Address - Zip Code:14129-9712
Practice Address - Country:US
Practice Address - Phone:716-532-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009760133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered