Individual
FANESSA RYDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPT
Contact information
Practice address
6300 CORPORATE CT STE 104, FORT MYERS, FL 33919-3513
(239) 340-1512
Mailing address
14071 CEDARDALE ST, FORT MYERS, FL 33905-7696
(239) 340-1512
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
24R2157
FL
Other
Enumeration date
11/07/2024
Last updated
11/07/2024
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