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Organization
BOWIE STATE UNIVERSITY
Active
Organization
BOWIE STATE UNIVERSITY
Active
Parent organization
BOWIE STATE UNIVERSITY
Other names
Henry Wise Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOWIE STATE UNIVERSITY
Authorized official
DR. ARTIE LEE TRAVIS ED.D. (VICE PRESIDENT STUDENT AFFAIRS)
(301) 860-3390
Entity
Organization
Contact information
Practice address
14000 JERICHO PARK ROAD, HENRY WISE WELLNESS CENTER, CMRC, LOWER LEVEL, BOWIE, MD 20715
(301) 860-4170
(601) 860-4179
Mailing address
14000 JERICHO PARK ROAD, HENRY WISE WELLNESS CENTER, CMRC, LOWER LEVEL, BOWIE, MD 20715
(301) 860-4170
(601) 860-4179
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
—
NULL
202K00000X
Phlebology Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
Primary
—
NULL
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
—
NULL
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
—
—
Other
Enumeration date
02/27/2019
Last updated
02/27/2019
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