Provider Demographics
NPI:1063879401
Name:FONTES, KAREN
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:FONTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:FONTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:INDEPENDENT PROVIDER
Mailing Address - Street 1:2745 25TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-3672
Mailing Address - Country:US
Mailing Address - Phone:330-454-8212
Mailing Address - Fax:
Practice Address - Street 1:2745 25TH ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-3672
Practice Address - Country:US
Practice Address - Phone:330-454-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant