Provider Demographics
NPI:1326475062
Name:TOWERY, FAUNE HART (LAC)
Entity Type:Individual
Prefix:MS
First Name:FAUNE
Middle Name:HART
Last Name:TOWERY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 FUNNY CIDE ST APT 205
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2060
Mailing Address - Country:US
Mailing Address - Phone:510-684-6986
Mailing Address - Fax:
Practice Address - Street 1:1834 SOSCOL AVE STE C
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1352
Practice Address - Country:US
Practice Address - Phone:510-684-6986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15292171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist