Individual
BRENDA FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 SOUTH BLISS AVENUE, TAHLEQUAH, OK 74464
(918) 458-3100
Mailing address
100 SOUTH BLISS AVENUE, TAHLEQUAH, OK 74464
(918) 458-3100
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
71524
OK
Other
Enumeration date
02/08/2019
Last updated
02/08/2019
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