MEDICARE: NATALIE D FAKUNLE

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1609614791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE D FAKUNLE

Provider Business Mailing Address
First Line	:	9714 DRY CREEK CT
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2083
Country	:	US
Telephone Number	:	346-754-6568
Fax Number	:

Provider Business Practice Location Address
First Line	:	9714 DRY CREEK CT
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2083
Country	:	US
Telephone Number	:	346-754-6568
Fax Number	:

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

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	07/15/2024

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