Provider Demographics
NPI:1396222782
Name:FOWLER, MIE S (APRN)
Entity Type:Individual
Prefix:
First Name:MIE
Middle Name:S
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 1:75 PUUHONU PL STE 100
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2000
Mailing Address - Country:US
Mailing Address - Phone:808-933-3800
Mailing Address - Fax:808-933-3801
Practice Address - Street 1:75 PUUHONU PL STE 100
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2000
Practice Address - Country:US
Practice Address - Phone:808-933-3800
Practice Address - Fax:808-933-3801
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN2476363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner