Provider Demographics
NPI:1578136180
Name:BOWENS, SEDRICA N
Entity Type:Individual
Prefix:
First Name:SEDRICA
Middle Name:N
Last Name:BOWENS
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 1:4246 HILLGATE CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-6739
Mailing Address - Country:US
Mailing Address - Phone:901-480-0802
Mailing Address - Fax:901-347-3355
Practice Address - Street 1:4246 HILLGATE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-6739
Practice Address - Country:US
Practice Address - Phone:901-480-0802
Practice Address - Fax:901-347-3355
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier