Healthcare Provider Details

I. General information

NPI: 1235313586
Provider Name (Legal Business Name): JANE FOWLER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOWMAN DR STE E140
VOORHEES NJ
08043-9631
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 120
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-4263
  • Fax: 856-983-9362
Mailing address:
  • Phone: 856-355-0335
  • Fax: 856-355-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00096200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: