Healthcare Provider Details

I. General information

NPI: 1720575657
Provider Name (Legal Business Name): LAURYN FOWLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURYN ZIELINSKI MD

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
ANCHORAGE AK
99506-3702
US

IV. Provider business mailing address

5955 ZEAMER AVE
ANCHORAGE AK
99506-3702
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-4242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number35.138525
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.138525
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: