Healthcare Provider Details

I. General information

NPI: 1588815138
Provider Name (Legal Business Name): DORIAN E FOWLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DORIAN Y ELMORE

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 KENDALL DR
GRANTS PASS OR
97527-5456
US

IV. Provider business mailing address

881 KENDALL DR
GRANTS PASS OR
97527-5456
US

V. Phone/Fax

Practice location:
  • Phone: 319-850-7607
  • Fax:
Mailing address:
  • Phone: 319-850-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number201408271CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: