Individual
DORIAN E FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
881 KENDALL DR, GRANTS PASS, OR 97527-5456
(319) 850-7607
Mailing address
881 KENDALL DR, GRANTS PASS, OR 97527-5456
(319) 850-7607
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
201408271CRNA
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588815138
WELLMARK BLUE CROSS BLUE SHIELD
IA
05
—
1588815138
—
IA
01
—
P00662680
RAILROAD MEDICARE
IA
Enumeration date
10/01/2008
Last updated
07/08/2015
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