Organization · Type 2 NPI

Bowie State University

Adult Health Nurse Practitioner · Bowie, MD

NPI number 1154888048 Active

Practice location

14000 Jericho Park Road, Henry Wise Wellness Center, Cmrc, Lower Level
Bowie, MD 20715

Fax (601) 860-4179

Specialties and licenses

Taxonomy	Code	License
Phlebology Physician	202K00000X	None listed
Internal Medicine Physician	207R00000X	None listed
Adult Health Nurse Practitioner Primary	363LA2200X	None listed
Obstetrics & Gynecology Nurse Practitioner	363LX0001X	None listed

Adult Health Nurse Practitioner: Definition to come...

Another provider at this address

Varsity Professional Rehabilitation and Staffing, LLCSports Physical Therapist Bowie, MD NPI 1841534468

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NPI record

NPI: 1154888048
Entity type: Organization (Type 2)
Issued: Feb 27, 2019
Last updated: Feb 27, 2019
Status: Active
Subpart: Yes of Bowie State University

Other names

Henry Wise Wellness Center · other name

Authorized official

Dr. Artie Lee Travis, ED.D.
Vice President Student Affairs
(301) 860-3390

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1154888048

Bowie State University's National Provider Identifier is 1154888048, issued on Feb 27, 2019. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in Bowie, MD. The record was last updated on Feb 27, 2019.