| NPI | 1184066102 |
|---|---|
| Former Name | DIONDRA RESCHELLE FOWLKES; SPEIGHT; BOLES; FULLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NC 60261) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2013-07-18 |