Individual
TANYA L FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
313 WALNUT ST STE 110, WILMINGTON, NC 28401-4063
(910) 668-0268
(910) 446-8622
Mailing address
554 KELLY RD, WILMINGTON, NC 28409-3160
(910) 388-4716
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
193358
NC
Other
Enumeration date
10/13/2023
Last updated
04/25/2024
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