{
"Npi": {
"NPI": "1487403697",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FOWLER",
"FirstName": "ANDREA",
"MiddleName": "LANAE SPARKMAN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DO, MBA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SPARKMAN",
"OtherFirstName": "ANDREA",
"OtherMiddleName": "LANAE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DO, MBA",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3600 NW SAMARITAN DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORVALLIS",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97330-5472",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "541-768-4906",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3600 NW SAMARITAN DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CORVALLIS",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97330-5472",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "541-768-4906",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/20/2024",
"LastUpdateDate": "08/20/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "220411",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "226720",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}