Healthcare Provider Details

I. General information

NPI: 1679666085
Provider Name (Legal Business Name): WENDY S BOWLES CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 YANKEE PARK PL
CENTERVILLE OH
45458-1878
US

IV. Provider business mailing address

2912 SPRINGBORO W
MORAINE OH
45439-1674
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-1115
  • Fax: 937-424-4721
Mailing address:
  • Phone: 937-297-8999
  • Fax: 937-298-9673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN253319, NP04921
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: