Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 13-1415 | AZ |
NPI | 1124441043 |
---|---|
Provider Name | Dr. De Adrea Dishonna Fontaine |
First Address | Gilbert, AZ 85296-4202 |
Second Address | Gilbert, AZ 85296-4202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2014 |
Last Update Date | 29/01/2014 |