Provider Demographics
NPI:1699009027
Name:FOWLER, KATRINA (RN)
Entity Type:Individual
Prefix:
First Name:KATRINA
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 1:45 LOCUST ST
Mailing Address - Street 2:APT #516
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-7000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 LOCUST ST
Practice Address - Street 2:APT #516
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-7000
Practice Address - Country:US
Practice Address - Phone:603-313-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262721163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse