Provider Demographics
NPI:1083629430
Name:FOWLER, JENIFER ELAINE (APRN)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:ELAINE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E C ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5411
Mailing Address - Country:US
Mailing Address - Phone:308-221-6068
Mailing Address - Fax:308-221-6071
Practice Address - Street 1:118 E C ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5411
Practice Address - Country:US
Practice Address - Phone:308-221-6068
Practice Address - Fax:308-221-6071
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110519363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health