Individual
JACLYN MARIE FONTAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-5000
Mailing address
19231 TREE CT, MACOMB, MI 48044-1427
(586) 649-8018
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704338036
MI
Other
Enumeration date
04/30/2021
Last updated
03/12/2024
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