Provider Demographics
NPI:1003134065
Name:ROWE, DECHANTA NICOLE
Entity Type:Individual
Prefix:
First Name:DECHANTA
Middle Name:NICOLE
Last Name:ROWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 S PARK CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3077
Mailing Address - Country:US
Mailing Address - Phone:866-931-1545
Mailing Address - Fax:703-563-0572
Practice Address - Street 1:4713 S PARK CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3077
Practice Address - Country:US
Practice Address - Phone:866-931-1545
Practice Address - Fax:703-563-0572
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10L19808164W00000X, 372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No372600000XNursing Service Related ProvidersAdult Companion