Doctor Name: | AUGUSTINA FAKIYESI |
NPI Number: | 1013373786 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SP015662 |
Business Practice Address: | 1841 Yost Rd Blue Bell, PA - 194223640 |
Business Phone Number: | 4842137193 |
Business Fax Number: | |
Mailing Address: | 1841 Yost Rd, BLUE BELL |
State: | PA |
Postal Code: | 194223640 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/11/2016 |
NPI Last Update Date: | 01/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | SP015662 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |