Healthcare Provider Details

I. General information

NPI: 1801990981
Provider Name (Legal Business Name): AUDREY FOWLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 SW MARLOW SUITE 110
PORTLAND OR
97225-5185
US

IV. Provider business mailing address

1815 SW MARLOW SUITE 110
PORTLAND OR
97225-5185
US

V. Phone/Fax

Practice location:
  • Phone: 503-292-0765
  • Fax: 503-292-5208
Mailing address:
  • Phone: 503-292-0765
  • Fax: 503-292-5208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: