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General NPI Number Information
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NPI Number | 1548200116
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Entity Type | Individual
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Provider Name | MARIECKEN FOWLER MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 11215 METRO PKWY STE 1
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City | FORT MYERS
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State | FL
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Zip | 33966-1206
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Country | US
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Telephone | 239-208-2212
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Fax |
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Provider Business Mailing Address
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Address Line | 11215 METRO PKWY BLDG 3
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City | FORT MYERS
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State | FL
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Zip | 33966-1206
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Country | US
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Telephone | 239-208-2212
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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 | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number | 0101238278
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2084D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
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License Number | 0101238278
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 2020035640
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 20637
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License Number State | NH
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Taxonomy #5
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD473597
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | S9132
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 0101238278
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License Number State | VA
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Taxonomy #8
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME146337
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License Number State | FL
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Taxonomy #9
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME146337
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License Number State | FL
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