Provider Demographics
NPI:1114170461
Name:FOWLER, ROBERT RICHARD JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RICHARD
Last Name:FOWLER
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ROCKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-4113
Mailing Address - Country:US
Mailing Address - Phone:978-388-9213
Mailing Address - Fax:
Practice Address - Street 1:21 ROCKY HILL RD
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-4113
Practice Address - Country:US
Practice Address - Phone:978-388-9213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56723164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0713104OtherMASS HEALTH