Individual
MISS MICHELLE MAE FOWLES CEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
622 BODART ST, GREEN BAY, WI 54301-4923
(920) 437-9773
Mailing address
825 N CLAY ST, DE PERE, WI 54115-3627
(920) 492-6160
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9463-33
WI
Other
Enumeration date
08/23/2019
Last updated
08/23/2019
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