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NPI Code Detail

MEDICARE: MRS. ANGIE MARIE FUQUA M.A.

MEDICARE: MRS. ANGIE MARIE FUQUA M.A.
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1891050126
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGIE MARIE FUQUA M.A.
Provider Business Mailing Address
First Line : 6267 WEBSTER CHURCH RD
Second Line :
City : DEXTER
State : MI
Zip : 48130-9659
Country : US
Telephone Number : 734-972-2550
Fax Number :
Provider Business Practice Location Address
First Line : 100 N STAEBLER RD STE B
Second Line :
City : ANN ARBOR
State : MI
Zip : 48103-9862
Country : US
Telephone Number : 734-252-6522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2012
Last Update Date : 07/24/2024

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