Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA17107 | FL |
NPI | 1710223680 |
---|---|
Provider Name | Lynn Fowlkes |
First Address | Deerfield Beach, FL 33442-3413 |
Second Address | Deerfield Beach, FL 33442-3413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2012 |
Last Update Date | 21/12/2012 |