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General NPI Number Information
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NPI Number | 1215914932
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Entity Type | Individual
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Provider Name | FONDA GAY LAFRENZ CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3601 ODONNELL ST
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City | BALTIMORE
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State | MD
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Zip | 21224-5238
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Country | US
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Telephone | 410-864-4493
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Fax |
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Provider Business Mailing Address
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Address Line | 201 SHAWNEE ST
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City | HIAWATHA
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State | KS
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Zip | 66434-2125
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Country | US
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Telephone | 785-742-2396
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Fax | 785-742-2539
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R156028
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 45654
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License Number State | KS
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