Most Relevant Information
Provider Data
| NPI Number: | 1003231374 |
| Provider Name: | ALLYSON RAE FITZWATER |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/24/2014 |
| Last Updated: | 02/24/2014 |
Provider Practice Location
3001 WARRIOR LN
POPLAR BLUFF
MO
639018685
Practice Location Phone/Fax
| Phone: | 5736861200 |
| Fax: |
Provider Mailing Location
3001 WARRIOR LN
POPLAR BLUFF
MO
639018685
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |