Individual
FANTASIA MARIE MACEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 W POPLAR ST, WALLA WALLA, WA 99362-2846
(509) 897-3320
Mailing address
1911 SUNSET DR, WALLA WALLA, WA 99362-4443
(509) 386-2571
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN61172658
WA
Other
Enumeration date
05/06/2022
Last updated
05/06/2022
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