Fanta Suwaneh, PA

NPI #1497340228 in Grapevine, Texas

Provider Information

NPI Number: 1497340228
Entity Type: Individual
Name: Fanta Suwaneh, PA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Mar 3, 2021
Last Updated: Sep 18, 2021

Practice Location

Address: 3801 WILLIAM D TATE AVE # 800A
City: Grapevine
State: Texas
ZIP Code: 76051-8755
Phone: (817) 488-8998

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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