Provider Demographics
NPI:1457885808
Name:FOWLER, TONDALA (CAMS,BS)
Entity Type:Individual
Prefix:
First Name:TONDALA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:CAMS,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 TEEL PARKWAY , TLC ENTERPRISE,LLC
Mailing Address - Street 2:SUITE 100-5222
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:214-577-8664
Mailing Address - Fax:214-305-6911
Practice Address - Street 1:8811 TEEL PARKWAY , TLC ENTERPRISE,LLC
Practice Address - Street 2:SUITE 100-5222
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:214-577-8664
Practice Address - Fax:214-305-6911
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14692890171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor