Provider Demographics
NPI:1275088122
Name:FELLOWS, KATY
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CANYON RD APT 1303
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-6215
Mailing Address - Country:US
Mailing Address - Phone:530-263-3801
Mailing Address - Fax:
Practice Address - Street 1:3200 CANYON RD APT 1303
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-6215
Practice Address - Country:US
Practice Address - Phone:530-263-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other