MEDICARE: MS. DEBRA JEAN FOWLER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	394404-1	NY
2	171M00000X	Case Manager/Care Coordinator		NY

General Provider Information

NPI Number	:	1396928420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA JEAN FOWLER RN

Provider Business Mailing Address
First Line	:	PO BOX 1282
Second Line	:
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-7282
Country	:	US
Telephone Number	:	518-891-6598
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 SCHOOL ST
Second Line	:
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-1625
Country	:	US
Telephone Number	:	518-891-6598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	06/18/2012

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