Basic Information
| Provider Information | |||||||||
| NPI: | 1053824177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOWDER | ||||||||
| FirstName: | HAYGEN | ||||||||
| MiddleName: | EKATERINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46101 COUNTRY LAKE DR | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIRSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439507700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403915572 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1750 SOUTHGATE PKWY | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437253024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404323634 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2017 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN89137 | WV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | APRN.CNP.022035 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.