Individual
MS. STACEY FONDREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATP
Contact information
Practice address
2111 FM 1960 RD E, HUMBLE, TX 77338-5229
(832) 445-0956
Mailing address
18802 ATASCA SOUTH DR, HUMBLE, TX 77346-4813
(832) 319-9980
(888) 873-7414
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
85967
TX
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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