Provider Demographics
NPI:1669668067
Name:BOWENS, JUANITA (PHD - RD)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:
Last Name:BOWENS
Suffix:
Gender:F
Credentials:PHD - RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 WESTFERN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1701
Mailing Address - Country:US
Mailing Address - Phone:803-781-2818
Mailing Address - Fax:803-781-2891
Practice Address - Street 1:98 WESTFERN CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1701
Practice Address - Country:US
Practice Address - Phone:803-781-2818
Practice Address - Fax:803-781-2891
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC803863133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered