Individual
TRACEY LYNN FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
110 CAMPUS DR, BRADFORD, PA 16701-1982
(814) 362-6535
Mailing address
26 N PINE ST, PORT ALLEGANY, PA 16743-1344
(716) 307-3714
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP009428
PA
Other
Enumeration date
11/17/2006
Last updated
02/21/2016
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