Doctor Name: | DEBORAH B FAHS |
NPI Number: | 1124027180 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 001829 |
Business Practice Address: | 850 N Main Street Ext. Bldg 2 Suite C2 Wallingford, CT - 06492 |
Business Phone Number: | 2032699778 |
Business Fax Number: | 2039491544 |
Mailing Address: | 850 N Main Street Ext, Bldg 2 Suite C2 WALLINGFORD |
State: | CT |
Postal Code: | 064922400 |
Phone Number: | 2032699778 |
Fax Number: | 2039491544 |
NPI Enumeration Date: | 07/20/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 001829 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |