Provider Demographics
NPI:1013697739
Name:STOWELL, TROY WILTON-CORTEZ
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:WILTON-CORTEZ
Last Name:STOWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E DANNA AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6422
Mailing Address - Country:US
Mailing Address - Phone:907-357-7519
Mailing Address - Fax:
Practice Address - Street 1:301 E DANNA AVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6422
Practice Address - Country:US
Practice Address - Phone:907-357-7519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker