Individual
MRS. MICHELLE MARIE FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
15 6TH ST, CLINTONVILLE, WI 54929-1624
(920) 851-8051
Mailing address
N9720 STATE ROAD 49, IOLA, WI 54945-9286
(414) 418-0489
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
30768-31
WI
Other
Enumeration date
07/02/2019
Last updated
07/02/2019
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