Individual
BRENDA FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
966 W. 21ST STREET, CHICAGO, IL 60608
(773) 254-1400
Mailing address
966 W 21ST ST, CHICAGO, IL 60608-4511
(773) 254-1400
(773) 650-1239
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041413998
IL
367A00000X
Advanced Practice Midwife
Primary
209015043
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IL
Enumeration date
12/28/2016
Last updated
12/28/2016
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