Healthcare Provider Details

I. General information

NPI: 1295172708
Provider Name (Legal Business Name): KENDRA DAWN BOWLING STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 US 52 ROOM 7
ABERDEEN OH
45101-1102
US

IV. Provider business mailing address

847 US 52 ROOM 7
ABERDEEN OH
45101-1102
US

V. Phone/Fax

Practice location:
  • Phone: 513-535-4910
  • Fax:
Mailing address:
  • Phone: 513-535-4910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number401488430213
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number401488430213
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401488430213
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: