Provider Demographics
NPI:1164818837
Name:FOWLE, ELIZABETH STANLEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STANLEY
Last Name:FOWLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15109
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-5109
Mailing Address - Country:US
Mailing Address - Phone:910-452-8633
Mailing Address - Fax:910-452-8569
Practice Address - Street 1:1709 S 16TH ST STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6491
Practice Address - Country:US
Practice Address - Phone:910-452-8633
Practice Address - Fax:910-452-8569
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily