Provider Demographics
NPI:1407229057
Name:FONTAINE, YOULA
Entity Type:Individual
Prefix:
First Name:YOULA
Middle Name:
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 LINDEN BLVD
Mailing Address - Street 2:5-A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2764
Mailing Address - Country:US
Mailing Address - Phone:347-948-1313
Mailing Address - Fax:
Practice Address - Street 1:362 LINDEN BLVD
Practice Address - Street 2:5-A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2764
Practice Address - Country:US
Practice Address - Phone:347-948-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314700164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse