Healthcare Provider Details

I. General information

NPI: 1629606561
Provider Name (Legal Business Name): KAREN DENISE BOWIE CRNP-FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3574
US

IV. Provider business mailing address

6803 PAINTER TER
CAPITOL HEIGHTS MD
20743-3320
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-8118
  • Fax:
Mailing address:
  • Phone: 301-648-5456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR110084
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: