Healthcare Provider Details

I. General information

NPI: 1730928490
Provider Name (Legal Business Name): FLOR FUENTES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N CAMERON ST STE 100
WINCHESTER VA
22601-6018
US

IV. Provider business mailing address

301 N CAMERON ST STE 100
WINCHESTER VA
22601-6018
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-1680
  • Fax: 540-662-5321
Mailing address:
  • Phone: 540-536-1680
  • Fax: 540-662-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002104478
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: