Provider Demographics
NPI:1407167026
Name:FONTAINE, CARYN B (CCE,CLD)
Entity Type:Individual
Prefix:MRS
First Name:CARYN
Middle Name:B
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:CCE,CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N MAIN ST
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5647
Mailing Address - Country:US
Mailing Address - Phone:864-386-2932
Mailing Address - Fax:
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:SUITE 8A
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5647
Practice Address - Country:US
Practice Address - Phone:864-386-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula