Provider Demographics
NPI:1790405546
Name:MOWRY, CHADD ADAM (RN)
Entity Type:Individual
Prefix:
First Name:CHADD
Middle Name:ADAM
Last Name:MOWRY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 FIVE POINTS DR UNIT 112
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2372
Mailing Address - Country:US
Mailing Address - Phone:248-762-1219
Mailing Address - Fax:
Practice Address - Street 1:3200 FIVE POINTS DR UNIT 112
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2372
Practice Address - Country:US
Practice Address - Phone:248-762-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704305521163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse