Provider Demographics
NPI:1851780688
Name:FOWLER, LAUREN (NP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3634
Mailing Address - Country:US
Mailing Address - Phone:770-380-9770
Mailing Address - Fax:
Practice Address - Street 1:316 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2480
Practice Address - Country:US
Practice Address - Phone:406-541-0032
Practice Address - Fax:406-541-0037
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN218432363LF0000X
MTNUR-APRN-LIC-126175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily