Provider Demographics
NPI:1750668760
Name:FOUNTAIN, ASIA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:ASIA
Middle Name:LYNN
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 MARK DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3923
Mailing Address - Country:US
Mailing Address - Phone:440-735-1470
Mailing Address - Fax:
Practice Address - Street 1:6118 MARK DR
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-3923
Practice Address - Country:US
Practice Address - Phone:440-735-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH362903163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse