Provider Demographics
NPI:1821602749
Name:BOWIE, WANDAR
Entity Type:Individual
Prefix:
First Name:WANDAR
Middle Name:
Last Name:BOWIE
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 1:743 PARK RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1517
Mailing Address - Country:US
Mailing Address - Phone:202-839-6094
Mailing Address - Fax:
Practice Address - Street 1:1315 S ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6925
Practice Address - Country:US
Practice Address - Phone:202-538-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide