Healthcare Provider Details

I. General information

NPI: 1447682208
Provider Name (Legal Business Name): JENNY MARIE FONSECA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2013
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 BEDFORD ST #501
FALL RIVER MA
02720
US

IV. Provider business mailing address

191 BEDFORD ST #501
FALL RIVER MA
02720
US

V. Phone/Fax

Practice location:
  • Phone: 508-235-5445
  • Fax:
Mailing address:
  • Phone: 508-996-3991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN277710
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number277710
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: