Individual
JODY FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
708 MAGAZINE ST, LOUISVILLE, KY 40203-2043
(502) 589-6000
(502) 589-8771
Mailing address
101 W. MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1451
(502) 589-6000
(502) 589-8711
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2032302
KY
Other
Enumeration date
10/07/2010
Last updated
05/29/2014
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