Healthcare Provider Details

I. General information

NPI: 1528670858
Provider Name (Legal Business Name): QIERON LENAE BOWIE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1590
US

IV. Provider business mailing address

815 N PATTERSON PARK AVE
BALTIMORE MD
21205-1621
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-9541
  • Fax:
Mailing address:
  • Phone: 410-949-5197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR209308
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR209308
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: