Healthcare Provider Details

I. General information

NPI: 1417828252
Provider Name (Legal Business Name): MOLLY FLORENCE FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8674 SANTA ROSA RD
ATASCADERO CA
93422-5428
US

IV. Provider business mailing address

8674 SANTA ROSA RD
ATASCADERO CA
93422-5428
US

V. Phone/Fax

Practice location:
  • Phone: 805-610-7173
  • Fax:
Mailing address:
  • Phone: 805-610-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number843510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: