MEDICARE: MS. DEIRDRE VYVYAN FOWLER RN-NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	76688-030	WI

General Provider Information

NPI Number	:	1194939918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEIRDRE VYVYAN FOWLER RN-NP

Provider Business Mailing Address
First Line	:	3307 N BARTLETT AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3025
Country	:	US
Telephone Number	:	414-332-3428
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 S 7TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3538
Country	:	US
Telephone Number	:	414-645-8383
Fax Number	:	414-645-8803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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