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General NPI Number Information
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NPI Number | 1124154265
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Entity Type | Individual
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Provider Name | DEBORAH A FOWLER D.O.M., L.AC.
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Gender | Female
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10597 BRAGG AVE
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5502
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Country | US
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Telephone | 530-277-6559
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Fax |
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Provider Business Mailing Address
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Address Line | 10597 BRAGG AVE
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5502
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Country | US
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Telephone | 530-277-6559
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 9990
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 580
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License Number State | NM
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