Provider Demographics
NPI:1598100430
Name:FOWLER, CASEY VOHN (ARNP)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:VOHN
Last Name:FOWLER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 WESTLAKE AVE N
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-6227
Mailing Address - Country:US
Mailing Address - Phone:509-368-4650
Mailing Address - Fax:
Practice Address - Street 1:1633 WESTLAKE AVE N
Practice Address - Street 2:SUITE 105
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-6227
Practice Address - Country:US
Practice Address - Phone:509-368-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60339515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily