Individual
LA KRISTA FANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
250 FLANK RD, PETERSBURG, VA 23805-9117
(804) 861-2223
Mailing address
20010 OAKLAND AVE, SOUTH CHESTERFIELD, VA 23834-5709
(804) 590-4282
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0001289588
VA
Other
Enumeration date
07/16/2020
Last updated
07/16/2020
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