Individual
MRS. JACQUELINE ANN FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT,ATC
Contact information
Practice address
120 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1562
(336) 765-5664
(336) 768-6713
Mailing address
120 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1562
(336) 765-5664
(336) 768-6713
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2075
NC
Other
Enumeration date
12/22/2016
Last updated
12/22/2016
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