Provider Demographics
NPI:1922493659
Name:FOWLER, STEPHANIE ROXIE
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ROXIE
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 1:3701 CARLYLE CLOSE
Mailing Address - Street 2:APT 1050
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1873
Mailing Address - Country:US
Mailing Address - Phone:334-300-1942
Mailing Address - Fax:
Practice Address - Street 1:3701 CARLYLE CLOSE
Practice Address - Street 2:APT 1050
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1873
Practice Address - Country:US
Practice Address - Phone:334-300-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS10746390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program