Individual
IVELISSE FONTANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN
Contact information
Practice address
CALLE 5 D-19 ESTANCIAS DEL MADRIGAL, RIO GRANDE, PR 00745
(787) 596-5144
Mailing address
PO BOX 3382, RIO GRANDE, PR 00745-3382
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
Primary
31455
PR
163WP0808X
Psychiatric/Mental Health Registered Nurse
31455
PR
Other
Enumeration date
11/17/2010
Last updated
11/17/2010
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