Provider Demographics
NPI:1497171375
Name:MCFOWLER, DORIDA
Entity Type:Individual
Prefix:
First Name:DORIDA
Middle Name:
Last Name:MCFOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 LEOPOLD WAY
Mailing Address - Street 2:206
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3561
Mailing Address - Country:US
Mailing Address - Phone:608-622-5460
Mailing Address - Fax:
Practice Address - Street 1:3313 LEOPOLD WAY
Practice Address - Street 2:206
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-3561
Practice Address - Country:US
Practice Address - Phone:608-622-5460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI317631-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse