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General NPI Number Information
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NPI Number | 1790123016
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Entity Type | Individual
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Provider Name | BRITTANY NICOLE FOWLER RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 06/09/2013
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Last Update Date | 06/09/2013
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Provider Practice Location Address
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Address Line | 4218 AVENUE OF THE CITIES
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City | MOLINE
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State | IL
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Zip | 61265-4544
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Country | US
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Telephone | 309-762-0200
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Fax | 309-762-0232
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Provider Business Mailing Address
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Address Line | 4218 AVENUE OF THE CITIES
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City | MOLINE
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State | IL
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Zip | 61265-4544
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Country | US
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Telephone | 309-762-0200
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Fax | 309-762-0232
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1093468
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License Number State | IL
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