Provider Demographics
NPI:1881077972
Name:FOWLER, KRISTEN MARIE (RN, FNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RN, FNP
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Mailing Address - Street 1:5 NEPONSET ST
Mailing Address - Street 2:WOT 2ND FL, STE C203
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-460-3291
Mailing Address - Fax:508-481-3706
Practice Address - Street 1:221 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5804
Practice Address - Country:US
Practice Address - Phone:617-732-5666
Practice Address - Fax:617-525-0436
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2020-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2270516363LF0000X
MARN2270516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily