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General NPI Number Information
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NPI Number | 1043412695
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Entity Type | Individual
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Provider Name | AMANDA C FOWLER CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 1315 ROBERTS STREET
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City | CAMDEN
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State | SC
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Zip | 29020-3737
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Country | US
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Telephone | 803-432-4311
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Fax | 910-715-1943
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Provider Business Mailing Address
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Address Line | 1315 ROBERTS STREET
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City | CAMDEN
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State | SC
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Zip | 29020-3737
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Country | US
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Telephone | 803-432-4311
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Fax | 910-715-1926
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 89111
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 077506
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License Number State | SC
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