Most Relevant Information
Provider Data
| NPI Number: | 1003436361 |
| Provider Name: | YUTIV FUQUA LPN |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 2-066064 |
Most Important Dates
| Enumeration Date: | 04/16/2020 |
| Last Updated: | 04/16/2020 |
Provider Practice Location
4040 MEMORIAL PKWY SW
HUNTSVILLE
AL
358024364
Practice Location Phone/Fax
| Phone: | 2565331970 |
| Fax: | 2565324112 |
Provider Mailing Location
4040 MEMORIAL PKWY SW
HUNTSVILLE
AL
358024364
Provider Mailing Phone/Fax
| Phone: | 2565331970 |
| Fax: | 2565324112 |