Individual
MS. TERA MARIE FAWKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
488 BING ST, GRAND JUNCTION, CO 81504-6113
(970) 589-0027
Mailing address
488 BING ST, GRAND JUNCTION, CO 81504-6113
(970) 589-0027
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B4404799
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P586842
—
CO
Enumeration date
01/24/2023
Last updated
01/24/2023
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