Provider Demographics
NPI:1982467171
Name:CANUL, ZOWIE STARLIGHT
Entity type:Individual
Prefix:MRS
First Name:ZOWIE
Middle Name:STARLIGHT
Last Name:CANUL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ZOWIE
Other - Middle Name:STARLIGHT
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1825 MARIKA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5521
Mailing Address - Country:US
Mailing Address - Phone:907-474-0890
Mailing Address - Fax:907-474-3621
Practice Address - Street 1:3101 LATHROP ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7426
Practice Address - Country:US
Practice Address - Phone:907-474-0890
Practice Address - Fax:907-474-3621
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker