Healthcare Provider Details

I. General information

NPI: 1457271934
Provider Name (Legal Business Name): MOLLY DEE FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 S COLUSA AVE
MERIDIAN ID
83642-8481
US

IV. Provider business mailing address

4909 S COLUSA AVE
MERIDIAN ID
83642-8481
US

V. Phone/Fax

Practice location:
  • Phone: 707-206-2455
  • Fax:
Mailing address:
  • Phone: 707-206-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: