Provider Demographics
NPI:1659662708
Name:FOWLER, AMY (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 E MAIN ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7951
Mailing Address - Country:US
Mailing Address - Phone:301-524-2451
Mailing Address - Fax:
Practice Address - Street 1:32 E MAIN ST
Practice Address - Street 2:APT 1
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-7951
Practice Address - Country:US
Practice Address - Phone:301-524-2451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161562163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse