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General NPI Number Information
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NPI Number | 1871245886
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Entity Type | Individual
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Provider Name | JOSHUA R FOWLES
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Gender | Male
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 3500 VICTORIA ST VICTORIA BUILDING 360A
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City | PITTSBURGH
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State | PA
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Zip | 15261-0001
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Country | US
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Telephone | 412-383-5136
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Fax |
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Provider Business Mailing Address
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Address Line | 875 CHARLESTON RD
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City | RIPLEY
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State | WV
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Zip | 25271-1576
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Country | US
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Telephone | 801-655-3413
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 107836
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License Number State | WV
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