Healthcare Provider Details

I. General information

NPI: 1679609358
Provider Name (Legal Business Name): ROBYN DENISE FOWLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 COPPERMINE RD
WOODSBORO MD
21798
US

IV. Provider business mailing address

7691 ANVIL DR
FREDERICK MD
21701-8906
US

V. Phone/Fax

Practice location:
  • Phone: 301-845-6322
  • Fax: 301-845-7939
Mailing address:
  • Phone: 301-898-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR86110
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: