Provider Demographics
NPI:1669693958
Name:FOWLER, TERESA NICOLE (PA C)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:NICOLE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
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Mailing Address - Street 1:143 WEST 28TH STREET
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002
Mailing Address - Country:US
Mailing Address - Phone:201-339-4544
Mailing Address - Fax:
Practice Address - Street 1:94 OLD SHORT HILLS ROAD
Practice Address - Street 2:SAINT BARNABAS MEDICAL CENTER
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-322-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00029500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant