Individual
THERESA D FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
201 S 7TH ST, OZARK, AR 72949-3131
(479) 667-1590
Mailing address
2901 S 74TH ST, FORT SMITH, AR 72903-5156
(314) 364-7595
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A005460
AR
Other
Enumeration date
01/15/2018
Last updated
01/15/2018
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