Individual
AMANDA MAE LORENE FOWLER TEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
207 KING CIR, GOREVILLE, IL 62939-0020
(618) 663-8336
Mailing address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-7177
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
03/28/2023
Last updated
03/28/2023
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