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Individual

MORGAN BALTRUS FOWLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CPNP-PC

Contact information

Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-2676
Mailing address
260 HORIZON DR, RALEIGH, NC 27615-4922
(919) 488-0015
(919) 277-0066

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
239061
NC
363LP0200X
Pediatric Nurse Practitioner
5007725
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
239061
NCBON LICENSE NUMBER
NC
01
5007725
NCBON
NC
Enumeration date
06/15/2015
Last updated
10/29/2022
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