Healthcare Provider Details

I. General information

NPI: 1366781122
Provider Name (Legal Business Name): AUNKIA CHRISTINA FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 SHADY LN BOX 45
EVANSVILLE WY
82636
US

IV. Provider business mailing address

PO BOX 45 8101 SHADY LN
EVANSVILLE WY
82636
US

V. Phone/Fax

Practice location:
  • Phone: 307-259-6093
  • Fax: 307-237-3311
Mailing address:
  • Phone: 307-259-6093
  • Fax: 307-237-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: