Healthcare Provider Details

I. General information

NPI: 1326082900
Provider Name (Legal Business Name): ELIZABETH A FOWLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE. ML 2001
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE. ML 2001
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4408
  • Fax: 513-636-7337
Mailing address:
  • Phone: 513-636-4408
  • Fax: 513-636-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN263621
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.07261
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: