Provider Demographics
NPI:1679666085
Name:BOWLES, WENDY S (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:S
Last Name:BOWLES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8999
Mailing Address - Fax:937-298-9673
Practice Address - Street 1:1516 YANKEE PARK PL
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1878
Practice Address - Country:US
Practice Address - Phone:937-438-1115
Practice Address - Fax:937-424-4721
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN253319, NP04921208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH421534506122OtherCARESOURCE
OH2097387Medicaid
OH000000585419OtherANTHEM
OH2097387Medicaid
OH000000585419OtherANTHEM