Healthcare Provider Details

I. General information

NPI: 1336059500
Provider Name (Legal Business Name): TONI FUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SPRING ST
MARQUETTE MI
49855-4661
US

IV. Provider business mailing address

377 W CRESCENT ST
MARQUETTE MI
49855-3312
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-1181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704345543
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: