Provider Demographics
NPI:1154558880
Name:FERNANDEZ, ANNETTE MARIA (MED)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:MARIA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:MARIA
Other - Last Name:CHICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7202 GODFREY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2405
Mailing Address - Country:US
Mailing Address - Phone:910-978-5823
Mailing Address - Fax:
Practice Address - Street 1:7202 GODFREY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2405
Practice Address - Country:US
Practice Address - Phone:910-978-5823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-21
Last Update Date:2009-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist