Provider Demographics
NPI:1679846125
Name:FOWLER, AINA R
Entity Type:Individual
Prefix:
First Name:AINA
Middle Name:R
Last Name:FOWLER
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 1:9401 APHRODITE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1497
Mailing Address - Country:US
Mailing Address - Phone:907-336-1296
Mailing Address - Fax:907-336-1298
Practice Address - Street 1:9401 APHRODITE DR
Practice Address - Street 2:9401 APHRODITE DR
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1497
Practice Address - Country:US
Practice Address - Phone:907-336-1296
Practice Address - Fax:907-336-1298
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12858376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide