Provider Information for 1629748421
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TERESA FOWLER
Sex: Female
NPI: 1629748421
Last Updated: 2025-03-06
Certification Date: 2025-03-06
Certification Date: 2025-03-06
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1629748421 | ||||||||||||
| Enumeration Date | 2021-09-14 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 15173 NORTH RD FENTON, MI 48430-1381 United States Phone: 810-428-7909 | Fax: | ||||||||||||
| Primary Practice Address | 15173 NORTH RD FENTON, MI 48430-1381 United States Phone: 810-428-7909 | Fax: | ||||||||||||
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