Individual
CARLA FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2503 S MAIN ST, STE B, STAFFORD, TX 77477-5544
(281) 499-3004
Mailing address
301 UNIVERSITY BLVD, PROVIDER ENROLLMENT -- RT. 1022, GALVESTON, TX 77555-5302
(409) 747-0890
(409) 747-1023
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
670560
TX
Other
Enumeration date
02/22/2008
Last updated
02/22/2008
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