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General NPI Number Information
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NPI Number | 1164880068
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Entity Type | Organization
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Legal Business Name | JEANNE FUQUA, ND LLC
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 173 OAKWOOD AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06119-2141
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Country | US
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Telephone | 203-909-3578
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Fax |
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Provider Business Mailing Address
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Address Line | 400 DUTCH NECK RD G13
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City | EAST WINDSOR
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State | NJ
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Zip | 08520-1253
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Country | US
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Telephone | 203-909-3578
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEANNE FUQUA
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Credential | ND LAC
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Telephone | 203-909-3578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 649
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 356
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License Number State | CT
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