Provider Demographics
NPI:1962103499
Name:FOWLKES, CHRISTINA MARIE (RN, IBCLC, DOULA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:FOWLKES
Suffix:
Gender:F
Credentials:RN, IBCLC, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-0450
Mailing Address - Country:US
Mailing Address - Phone:865-556-9074
Mailing Address - Fax:
Practice Address - Street 1:25445 POINT LOOKOUT ROAD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2065
Practice Address - Country:US
Practice Address - Phone:865-556-9074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
MDR247210163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No374J00000XNursing Service Related ProvidersDoula