| NPI | 1760887376 |
|---|---|
| Former Name | LISA FOWLES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NM PA2014-0076) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM 134524022) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2023-07-05 |