Provider Demographics
NPI:1306645080
Name:FUENTES, LIZZY CORAL (CNM)
Entity type:Individual
Prefix:
First Name:LIZZY
Middle Name:CORAL
Last Name:FUENTES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:CT
Mailing Address - Zip Code:06263-0065
Mailing Address - Country:US
Mailing Address - Phone:401-500-0880
Mailing Address - Fax:
Practice Address - Street 1:163 STATE AVE
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:CT
Practice Address - Zip Code:06263
Practice Address - Country:US
Practice Address - Phone:401-500-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife