Provider Demographics
NPI:1053371526
Name:FOWLER, DANA (ARNP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-0909
Mailing Address - Country:US
Mailing Address - Phone:319-653-5481
Mailing Address - Fax:319-384-8557
Practice Address - Street 1:400 E POLK ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1237
Practice Address - Country:US
Practice Address - Phone:319-653-5481
Practice Address - Fax:319-384-8557
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA104824363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1450379Medicaid
IAQ28609Medicare UPIN
IA1450379Medicaid