Provider Demographics
NPI:1598816175
Name:FOW, CLAIRE GAYLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:GAYLE
Last Name:FOW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:48155 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4061
Mailing Address - Country:US
Mailing Address - Phone:810-499-5221
Mailing Address - Fax:586-739-8536
Practice Address - Street 1:48155 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4061
Practice Address - Country:US
Practice Address - Phone:810-499-5221
Practice Address - Fax:586-739-8536
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704122492163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health