Individual
MANDITHE M. FANFAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
450 E ATLANTIC BLVD, POMPANO BEACH, FL 33060-6256
(954) 580-0770
(954) 580-0777
Mailing address
11031 NE 6TH AVE, MIAMI, FL 33161-7182
(305) 398-6100
(305) 757-4465
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5177352
FL
Other
Enumeration date
09/25/2009
Last updated
09/25/2009
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