Provider Demographics
NPI:1851692776
Name:FOWLER, NORMA VIVICAN (RN)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:VIVICAN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:CLARA
Other - Last Name:VIVICAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:914 E 222ND ST
Mailing Address - Street 2:NEW YORK
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1018
Mailing Address - Country:US
Mailing Address - Phone:718-519-1105
Mailing Address - Fax:
Practice Address - Street 1:1663 E 17TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1259
Practice Address - Country:US
Practice Address - Phone:718-998-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129013163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool