Healthcare Provider Details

I. General information

NPI: 1114015872
Provider Name (Legal Business Name): MARY K DOWLING FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 SOQUEL DR CABRILLO COLLEGE STUDENT HEALTH SERVICES
APTOS CA
95003-3119
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 831-479-6528
  • Fax: 831-477-5634
Mailing address:
  • Phone: 408-287-7532
  • Fax: 408-287-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN550302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: