Healthcare Provider Details

I. General information

NPI: 1053994939
Provider Name (Legal Business Name): MR. DANDRE LATIEF BOWERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E MARKET ST
WARREN OH
44483-6641
US

IV. Provider business mailing address

1457 CENTRAL PARKWAY AVE SE
WARREN OH
44484-4458
US

V. Phone/Fax

Practice location:
  • Phone: 330-271-8486
  • Fax: 330-662-6601
Mailing address:
  • Phone: 330-406-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: