Individual
MRS. SHANNON MARIE FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1038 RESEARCH BLVD, MADISON, AL 35758-2069
(205) 379-0174
Mailing address
27717 KOSAR XING, ATHENS, AL 35613-7606
(256) 777-2620
(256) 265-7017
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
113275
AL
363LA2100X
Acute Care Nurse Practitioner
Primary
1-113275
AL
363LF0000X
Family Nurse Practitioner
32107
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134764608
—
AL
Enumeration date
11/08/2019
Last updated
08/16/2023
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