Provider Demographics
NPI:1891818712
Name:FOWLER, ANN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3074 WHITNEY AVE
Mailing Address - Street 2:BLDG 1, FLOOR 2
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2391
Mailing Address - Country:US
Mailing Address - Phone:203-287-7554
Mailing Address - Fax:203-287-2404
Practice Address - Street 1:3074 WHITNEY AVE
Practice Address - Street 2:BLDG 1, FLOOR 2
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2391
Practice Address - Country:US
Practice Address - Phone:203-287-7554
Practice Address - Fax:203-287-2404
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001695363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400001695CT02OtherANTHEM BLUE CROSS