Individual
BRANDON RAY FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
9675 N 5750 W, HIGHLAND, UT 84003-9150
(801) 369-0003
Mailing address
9675 N 5750 W, HIGHLAND, UT 84003-9150
(801) 369-0003
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
6581184-3101
UT
Other
Enumeration date
08/13/2013
Last updated
08/13/2013
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