Individual
DEBORAH A FOWLER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
P,A.-C
Contact information
Practice address
102 N ADELAIDE ST, FENTON, MI 48430-2670
(810) 629-2245
(810) 629-6535
Mailing address
16216 PINE LAKE FOREST DR, FENTON, MI 48430
(810) 629-8703
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601001505
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MF0924630
MEDICARE RR ID
MI
Enumeration date
03/08/2006
Last updated
07/09/2007
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