Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 110519 | NE |
NPI | 1083629430 |
---|---|
Provider Name | Jenifer Elaine Fowler |
First Address | North Platte, NE 69101-5411 |
Second Address | North Platte, NE 69101-5411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 06/01/2014 |