Individual
MARY THERESA FANTAZIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-5060
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(800) 994-0371
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1170828
TX
Other
Enumeration date
09/19/2024
Last updated
08/04/2025
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