Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD00046521 | WA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD00046521 | WA |
NPI | 1093733495 |
---|---|
Provider Name | Dr. Amber D Fowler |
First Address | Mount Vernon, WA 98273-5607 |
Second Address | Mount Vernon, WA 98273-5607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 29/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I59823 | (02) | WA |
MD00046521 | STATE LICENSE NUMBER (01) | WA |
P73421 | (02) | WA |