1043648108 NPI number — AMBER DAWN FOWLER CMHC

Table of content: AMBER DAWN FOWLER CMHC (NPI 1043648108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043648108 NPI number — AMBER DAWN FOWLER CMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOWLER
Provider First Name:
AMBER
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALDONADO
Provider Other First Name:
AMBER
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ACMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043648108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 297
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN RIVER
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84525-0297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-200-5551
Provider Business Mailing Address Fax Number:
435-344-4604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 E CENTER ST STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84532-2473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-200-5551
Provider Business Practice Location Address Fax Number:
435-344-4604
Provider Enumeration Date:
10/28/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  8483294-6004 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)