Individual
KRISTINE BOWERSOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1775 DEMPSTER ST STE E592C, PARK RIDGE, IL 60068-1143
(312) 609-0300
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004671
IL
363A00000X
Physician Assistant
8884
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100410618
—
WI
Enumeration date
08/22/2013
Last updated
04/16/2026
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