Provider Demographics
NPI:1710223680
Name:FOWLKES, LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:FOWLKES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 GRANTHAM E
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3413
Mailing Address - Country:US
Mailing Address - Phone:754-234-8424
Mailing Address - Fax:
Practice Address - Street 1:155 GRANTHAM E
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3413
Practice Address - Country:US
Practice Address - Phone:754-234-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA17107175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath