# BOWIE STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BOWIE STATE UNIVERSITY
- **Other names:** Henry Wise Wellness Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1154888048
- **Legal business name:** BOWIE STATE UNIVERSITY
- **Authorized official:** DR. ARTIE LEE TRAVIS ED.D. (VICE PRESIDENT STUDENT AFFAIRS)
- **Authorized official phone:** (301) 860-3390

## Contact information

- **Practice address:** 14000 JERICHO PARK ROAD, HENRY WISE WELLNESS CENTER, CMRC, LOWER LEVEL, BOWIE, MD 20715
- **Practice address phone:** (301) 860-4170
- **Practice address fax:** (601) 860-4179
- **Mailing address:** 14000 JERICHO PARK ROAD, HENRY WISE WELLNESS CENTER, CMRC, LOWER LEVEL, BOWIE, MD 20715
- **Mailing address phone:** (301) 860-4170
- **Mailing address fax:** (601) 860-4179

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202K00000X | Phlebology Physician | — | NULL | — |
| 202K00000X | Phlebology Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | — | NULL | — |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/27/2019
- **Last updated:** 02/27/2019