Most Relevant Information
Provider Data
| NPI Number: | 1003403866 |
| Provider Name: | FANTA KABA RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 793757 |
Most Important Dates
| Enumeration Date: | 12/28/2020 |
| Last Updated: | 12/28/2020 |
Provider Practice Location
100 W KINGSBRIDGE RD
BRONX
NY
104683961
Practice Location Phone/Fax
| Phone: | 7184101500 |
| Fax: |
Provider Mailing Location
1100 FRANKLIN AVE APT 3A
BRONX
NY
104565575
Provider Mailing Phone/Fax
| Phone: | 6463778166 |
| Fax: |