Provider Demographics
NPI:1124781547
Name:FOWLER, NATALIE MARISA (RN, BSN)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARISA
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:MARISA
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:4780 BALSOM RD
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-8719
Mailing Address - Country:US
Mailing Address - Phone:336-479-4445
Mailing Address - Fax:
Practice Address - Street 1:4780 BALSOM RD
Practice Address - Street 2:
Practice Address - City:PFAFFTOWN
Practice Address - State:NC
Practice Address - Zip Code:27040-8719
Practice Address - Country:US
Practice Address - Phone:336-479-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC276359163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine