Organization
TIVA OBA, L.L.C.
Active
Other names
DentTIVA or AOBA
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER PAUL BOWEN CRNA, APRN (PRESIDENT)
(502) 797-1567
Entity
Organization
Contact information
Practice address
4729 RAZOR CREEK WAY, LOUISVILLE, KY 40299-5533
(502) 797-1567
(502) 713-1979
Mailing address
4729 RAZOR CREEK WAY, LOUISVILLE, KY 40299-5533
(502) 797-1567
(502) 713-1979
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3005577
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100080880
—
KY
Enumeration date
06/22/2012
Last updated
06/22/2012
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