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Individual

JUSTIN FANTAZIER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1133 CULBERT DR, MARION, VA 24354-4211
(276) 706-6707
Mailing address
1133 CULBERT DR, MARION, VA 24354-4211

Taxonomy

Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
001231585
VA

Other

Enumeration date
07/28/2016
Last updated
07/28/2016
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