Provider Demographics
NPI:1821639725
Name:HUGHES, FANTASIA (LPN)
Entity Type:Individual
Prefix:
First Name:FANTASIA
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HAWTHORNE WAY APT 213
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3866
Mailing Address - Country:US
Mailing Address - Phone:989-780-7603
Mailing Address - Fax:
Practice Address - Street 1:103 HAWTHORNE WAY APT 213
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3866
Practice Address - Country:US
Practice Address - Phone:989-780-7603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN97782164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse