Provider Demographics
NPI:1356665889
Name:FUKUDA, CRISTIANE LEMOS (NP)
Entity Type:Individual
Prefix:MRS
First Name:CRISTIANE
Middle Name:LEMOS
Last Name:FUKUDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 NELSON BROGDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3480
Mailing Address - Country:US
Mailing Address - Phone:678-978-4801
Mailing Address - Fax:
Practice Address - Street 1:5212 PINE BRANCH CIR
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-7616
Practice Address - Country:US
Practice Address - Phone:678-978-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA158316363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health