Individual
RUBEN FUENTES
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1111 SUNSET DR, SUITE 4, JOHNSON CITY, TN 37604-3615
(423) 283-0776
(423) 283-0549
Mailing address
PO BOX 1070, JOHNSON CITY, TN 37605-1070
(423) 283-0776
(423) 283-0549
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN0000052244
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3605162
—
TN
Enumeration date
08/12/2005
Last updated
07/08/2007
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