Provider Demographics
NPI:1477228401
Name:VICTOR, ANGE NILSA FONTAINE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ANGE
Middle Name:NILSA FONTAINE
Last Name:VICTOR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 BOLLEN LN
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-4185
Mailing Address - Country:US
Mailing Address - Phone:404-632-7000
Mailing Address - Fax:
Practice Address - Street 1:323 BOLLEN LN
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-4185
Practice Address - Country:US
Practice Address - Phone:404-632-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN262617163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse