Individual
LISA FOWLKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATHLETIC TRAINER
Contact information
Practice address
926 HARDING ST, OREGON, WI 53575-2858
(414) 232-7850
Mailing address
926 HARDING ST, OREGON, WI 53575-2858
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1049-39
WI
Other
Enumeration date
01/03/2025
Last updated
01/03/2025
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