Individual
KISHA L BOWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1234 S 13TH AVE, MAYWOOD, IL 60153-1830
(708) 670-2835
Mailing address
1234 S 13TH AVE, MAYWOOD, IL 60153-1830
(708) 670-2835
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.032790
IL
Other
Enumeration date
10/07/2025
Last updated
10/07/2025
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