Individual
CANDACE FOWLKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
880 W LONG LAKE RD, TROY, MI 48098-4504
(866) 449-6828
Mailing address
700 STEWART RD, MONROE, MI 48162-5304
(313) 629-5759
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704323451
MI
Other
Enumeration date
04/19/2016
Last updated
03/17/2023
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