MEDICARE: PAMELA R. M. FOWLER-GREENE

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	235Z00000X	Speech-Language Pathologist	SA7661	FL
2	235Z00000X	Speech-Language Pathologist	SP-1428	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396845897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA R. M. FOWLER-GREENE

Provider Business Mailing Address
First Line	:	2012 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3151
Country	:	US
Telephone Number	:	702-360-1137
Fax Number	:

Provider Business Practice Location Address
First Line	:	2012 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3151
Country	:	US
Telephone Number	:	702-360-1137
Fax Number	:

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	09/15/2014

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Directions to “ PAMELA R. M. FOWLER-GREENE ” Practice Location

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