MEDICARE: MRS. RITA ILSE FONTAINE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-12549	NC

General Provider Information

NPI Number	:	1265193510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RITA ILSE FONTAINE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 96860
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28296-6860
Country	:	US
Telephone Number	:	919-761-5678
Fax Number	:

Provider Business Practice Location Address
First Line	:	13271 STRICKLAND RD STE 120
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-5228
Country	:	US
Telephone Number	:	919-741-4677
Fax Number	:	919-741-6349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2022
Last Update Date	:	01/06/2026

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