Healthcare Provider Details

I. General information

NPI: 1346279619
Provider Name (Legal Business Name): TODD THOMAS NOWLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E CAMBRIDGE AVE SUITE 301
PHOENIX AZ
85006-1459
US

IV. Provider business mailing address

1920 E CAMBRIDGE AVE SUITE 301
PHOENIX AZ
85006-1459
US

V. Phone/Fax

Practice location:
  • Phone: 602-241-7323
  • Fax: 602-462-5933
Mailing address:
  • Phone: 602-241-7323
  • Fax: 602-462-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number26850
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: