Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | F344685-01 | NY |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F344685-01 | NY |
NPI | 1194387522 |
---|---|
Provider Name | Daneille Fontaine |
First Address | Albany, NY 12208-3412 |
Second Address | Albany, NY 12208-3412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2019 |
Last Update Date | 07/07/2020 |