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General NPI Number Information
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NPI Number | 1265193510
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Entity Type | Individual
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Provider Name | RITA ILSE FONTAINE PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 13271 STRICKLAND RD STE 120
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City | RALEIGH
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State | NC
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Zip | 27613-5228
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Country | US
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Telephone | 919-741-4677
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Fax | 919-741-6349
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Provider Business Mailing Address
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Address Line | PO BOX 96860
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City | CHARLOTTE
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State | NC
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Zip | 28296-6860
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Country | US
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Telephone | 919-761-5678
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-12549
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License Number State | NC
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