Provider Demographics
NPI:1417828252
Name:FOWLER, MOLLY FLORENCE
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:FLORENCE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8674 SANTA ROSA RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-5428
Mailing Address - Country:US
Mailing Address - Phone:805-610-7173
Mailing Address - Fax:
Practice Address - Street 1:8674 SANTA ROSA RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5428
Practice Address - Country:US
Practice Address - Phone:805-610-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA843510163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics