| NPI | 1548511413 |
|---|---|
| Former Name | COLETTE RAE FUQUA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71004164A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71004164A) |
| 363L00000X Nurse Practitioner (Licence: TX AP134563) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 21004) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP134563) | |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2023-09-01 |