Healthcare Provider Details

I. General information

NPI: 1518931823
Provider Name (Legal Business Name): DONALD RAY FOWLER BSN-NURSING
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-2849
  • Fax: 757-953-2870
Mailing address:
  • Phone: 757-953-2849
  • Fax: 757-953-2870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number0001080522
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: