Individual
DESAREE FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP-PC
Contact information
Practice address
672 W 400 S STE 101, SPRINGVILLE, UT 84663-3170
(801) 491-9883
(801) 489-3141
Mailing address
1055 N 500 W, ATTN. CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
CNP-03137
NM
Other
Enumeration date
02/09/2017
Last updated
10/16/2023
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