Individual
DR. EDNITA CHARZETTE STREET FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, CRNA
Contact information
Practice address
1421 N 7TH ST, TERRE HAUTE, IN 47807-1005
(812) 231-4608
(812) 231-4675
Mailing address
3157 BASIN REFUGE RD, LUCEDALE, MS 39452-7688
(601) 947-0366
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
889173
MS
367500000X
Certified Registered Nurse Anesthetist
Primary
901702
MS
Other
Enumeration date
03/29/2021
Last updated
06/16/2021
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