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General NPI Number Information
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NPI Number | 1588097521
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Entity Type | Individual
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Provider Name | BRANDON RAY FOWLER LPN
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Gender | Male
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 9675 N 5750 W
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City | HIGHLAND
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State | UT
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Zip | 84003-9150
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Country | US
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Telephone | 801-369-0003
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Fax |
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Provider Business Mailing Address
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Address Line | 9675 N 5750 W
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City | HIGHLAND
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State | UT
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Zip | 84003-9150
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Country | US
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Telephone | 801-369-0003
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 6581184-3101
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License Number State | UT
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