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General NPI Number Information
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NPI Number | 1154888048
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Entity Type | Organization
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Legal Business Name | BOWIE STATE UNIVERSITY
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 14000 JERICHO PARK ROAD HENRY WISE WELLNESS CENTER, CMRC, LOWER LEVEL
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City | BOWIE
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State | MD
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Zip | 20715
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Country | US
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Telephone | 301-860-4170
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Fax | 601-860-4179
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Provider Business Mailing Address
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Address Line | 14000 JERICHO PARK ROAD HENRY WISE WELLNESS CENTER, CMRC, LOWER LEVEL
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City | BOWIE
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State | MD
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Zip | 20715
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Country | US
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Telephone | 301-860-4170
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Fax | 601-860-4179
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Authorized Official
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Title or Position | VICE PRESIDENT STUDENT AFFAIRS
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Name | DR. ARTIE LEE TRAVIS
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Credential | ED.D.
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Telephone | 301-860-3390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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