FANTA PHANNAVONG

PROVIDENCE, RI
NPI1518839703
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy172V00000X Community Health Worker
(Licence: RI  ISW02399)
Enumeration Date2025-09-18
Last Update Date2025-10-24
Business Address
FANTA PHANNAVONG
270 ELMWOOD AVE
PROVIDENCE, RI 02907-1524
Phone number: 401-274-8811
Mailing Address
FANTA PHANNAVONG
270 ELMWOOD AVE
PROVIDENCE, RI 02907-1524
Phone number: 401-274-8811
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