Healthcare Provider Details

I. General information

NPI: 1467816157
Provider Name (Legal Business Name): BILLIE MURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BILLIE RAE FOWLER FNP

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6270 SOM CENTER RD
SOLON OH
44139-2913
US

IV. Provider business mailing address

8567 PRESCOTT DR
CHESTERLAND OH
44026-3127
US

V. Phone/Fax

Practice location:
  • Phone: 440-836-0494
  • Fax:
Mailing address:
  • Phone: 440-339-3922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.342871
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.18976
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: