| NPI | 1760424410 |
|---|---|
| Former Name | LAURIE ANN FONTAINE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0110003712) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OA003294) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2023-09-18 |