Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lawanda S Fantroy

Individual provider Adult Health Nurse Practitioner · NPI 1093272874

Lawanda S Fantroy is a Nurse Practitioner in Mobile, Alabama. Qualified in 2021, 5 years ago. Practices with Imc-Diagnostic and Medical Clinic LLC, a 168-clinician group, works from 2 locations and offers telehealth. Licensed in Alabama and Minnesota.

Years since qualifying
5
Licensed in
AL, MN
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

1700 Spring Hill Ave Ste 100
Mobile, AL 36604-1416
Phone: (251) 435-1200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2925 Chicago Ave, Minneapolis, MN 55407-1321 — (612) 262-9000

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 1-122621 (AL)
Adult Health Nurse Practitioner Taxonomy 363LA2200X · Licence 20629 (MN)

Record details

NPI number1093272874
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 27, 2019
Last updated in NPPESFebruary 29, 2024
Certification dateFebruary 29, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Imc-Diagnostic And Medical Clinic Llc — 168 clinicians
Accepts Medicare assignment Not indicated
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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