Provider Demographics
NPI:1659883718
Name:FOWLER, RITA M (RN)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:M
Last Name:FOWLER
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 1:320 ROBINSON AVE. UNIT 203
Mailing Address - Street 2:NEW YORK HEALTH CARE
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3338
Mailing Address - Country:US
Mailing Address - Phone:845-569-8120
Mailing Address - Fax:845-569-8128
Practice Address - Street 1:33 WEST HAWTHORNE AVE. SUITE 31
Practice Address - Street 2:NEW YORK HEALTH CARE
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:718-375-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242209-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse