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Individual
MISS MELISSA SUE FOWLER
Active
Individual
MISS MELISSA SUE FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
001000050
NC
363A00000X
Physician Assistant
Primary
0010-00050
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2334668
GROUP
NC
01
—
84500
BCBS GROUP
NC
05
—
8984500
—
NC
Enumeration date
08/08/2006
Last updated
07/12/2021
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