Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 104824 | IA |
NPI | 1053371526 |
---|---|
Provider Name | Dana Fowler |
First Address | Washington, IA 52353-0909 |
Second Address | Washington, IA 52353-1237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 11/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1450379 | (05) | IA |
Q28609 | (02) | IA |