Healthcare Provider Details

I. General information

NPI: 1063463321
Provider Name (Legal Business Name): ROBIN H FONTANA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 SE 36TH ST SUITE 214
MERCER ISLAND WA
98040
US

IV. Provider business mailing address

PO BOX 1526
MERCER ISLAND WA
98040
US

V. Phone/Fax

Practice location:
  • Phone: 206-275-3588
  • Fax: 206-275-2073
Mailing address:
  • Phone: 206-275-3588
  • Fax: 206-275-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberAP30004797
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: