| Doctor Name: | LADY BOWENNESHEIM |
| NPI Number: | 1790175826 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 209.012098 |
| Business Practice Address: | 431 W Liberty St Wauconda, IL - 600842452 |
| Business Phone Number: | 8475262151 |
| Business Fax Number: | |
| Mailing Address: | 2125 S Tonne Dr Apt 122, ARLINGTON HEIGHTS |
| State: | IL |
| Postal Code: | 600054125 |
| Phone Number: | 6304862338 |
| Fax Number: | |
| NPI Enumeration Date: | 01/27/2015 |
| NPI Last Update Date: | 01/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209.012098 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |