Healthcare Provider Details

I. General information

NPI: 1306645080
Provider Name (Legal Business Name): LIZZY CORAL FUENTES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 STATE AVE
ROGERS CT
06263
US

IV. Provider business mailing address

PO BOX 65
ROGERS CT
06263-0065
US

V. Phone/Fax

Practice location:
  • Phone: 401-500-0880
  • Fax:
Mailing address:
  • Phone: 401-500-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11038592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: