Provider Demographics
NPI:1962441519
Name:FOWLER, SOPHIE MARIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIE
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 1:111 DOCTOR CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6502
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:
Practice Address - Street 1:111 DOCTOR CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6502
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0794Medicaid
SCAA69526868Medicare PIN
SCAA69525282Medicare PIN
SCAA69525281Medicare PIN
SCAA69526882Medicare PIN
SCQ107294889Medicare PIN
SCAA69527499Medicare PIN
SCQ10729Medicare UPIN
SCAA69527819Medicare PIN
SCAA69525277Medicare PIN
SCAA69527555Medicare PIN
SCAA69527498Medicare PIN
SCAA69527522Medicare PIN
SCAA69528798Medicare PIN
SCAA69526834Medicare PIN
SCAA69527006Medicare PIN
SCAA69527126Medicare PIN