Provider Demographics
NPI:1659929537
Name:FONTAINE, BRONTE ANNETTE
Entity Type:Individual
Prefix:
First Name:BRONTE
Middle Name:ANNETTE
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 1:7 BICKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3125
Mailing Address - Country:US
Mailing Address - Phone:207-951-1400
Mailing Address - Fax:
Practice Address - Street 1:7 BICKFORD AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3125
Practice Address - Country:US
Practice Address - Phone:207-951-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer