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Individual
MRS. STACEY P FOWLER
Active
Individual
MRS. STACEY P FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LAT, ATC, LMBT
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
333921
NC
2255A2300X
Athletic Trainer
0823
NC
225700000X
Massage Therapist
0417
NC
Other
Enumeration date
03/29/2006
Last updated
03/08/2024
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