Provider Demographics
NPI:1649927310
Name:FANFAN, MARIE BETTY (RN)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:BETTY
Last Name:FANFAN
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 1:5381 NW 41ST WAY
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-5028
Mailing Address - Country:US
Mailing Address - Phone:203-820-7700
Mailing Address - Fax:
Practice Address - Street 1:5381 NW 41ST WAY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-5028
Practice Address - Country:US
Practice Address - Phone:203-820-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9455266163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical