Individual
MS. BROOKE WEBSTER FUENTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
300 E BLACKSTOCK ROAD, SUITE E, SPARTANBURG, SC 29301
(864) 285-9861
(864) 595-8281
Mailing address
300 E BLACKSTOCK ROAD, SUITE E, SPARTANBURG, SC 29301
(864) 285-9861
(864) 595-8281
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1790
SC
363AS0400X
Surgical Physician Assistant
0110003582
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1484PA
—
SC
Enumeration date
06/02/2011
Last updated
01/13/2016
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