Doctor Name: | NICOLE FEARON |
NPI Number: | 1073942546 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 005480 |
Business Practice Address: | 2639 Main St Glastonbury, CT - 060332023 |
Business Phone Number: | 8606591329 |
Business Fax Number: | |
Mailing Address: | 99 Beaman Brk, BLOOMFIELD |
State: | CT |
Postal Code: | 060024005 |
Phone Number: | 8603716636 |
Fax Number: | |
NPI Enumeration Date: | 11/05/2013 |
NPI Last Update Date: | 11/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 005480 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |