Provider Demographics
NPI:1780235606
Name:FENTON, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:FENTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:PORCINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12195 POTOMAC VIEW RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20664-6301
Mailing Address - Country:US
Mailing Address - Phone:850-499-0755
Mailing Address - Fax:
Practice Address - Street 1:12195 POTOMAC VIEW RD
Practice Address - Street 2:
Practice Address - City:NEWBURG
Practice Address - State:MD
Practice Address - Zip Code:20664-6301
Practice Address - Country:US
Practice Address - Phone:850-499-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider