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General NPI Number Information
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NPI Number | 1437600616
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Entity Type | Individual
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Provider Name | MRS. KALEIGH MARIE FENTON
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Gender | Female
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Dates
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Enumeration Date | 10/22/2016
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Last Update Date | 10/22/2016
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE ATTN: MCHJ-CLQ-C
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City | TACOMA
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State | WA
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Zip | 98431-1100
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Country | US
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Telephone | 253-968-5090
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Fax |
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Provider Business Mailing Address
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Address Line | 2602 WESTRIDGE AVE W APT S304
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City | TACOMA
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State | WA
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Zip | 98466-8271
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Country | US
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Telephone | 636-524-5445
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 146076
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License Number State | MO
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