Provider Demographics
NPI:1316635758
Name:BOWSER, SHAFIA LANELLE
Entity type:Individual
Prefix:
First Name:SHAFIA
Middle Name:LANELLE
Last Name:BOWSER
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 1:1064 DAVIE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-9141
Mailing Address - Country:US
Mailing Address - Phone:252-678-3846
Mailing Address - Fax:
Practice Address - Street 1:1064 DAVIE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-9141
Practice Address - Country:US
Practice Address - Phone:252-678-3846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21638375343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)