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Individual
ERIC FAST
Active
Individual
ERIC FAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP60627369
WA
363L00000X
Nurse Practitioner
NP-1692A
ID
363LP2300X
Primary Care Nurse Practitioner
Primary
NP-1692A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376918383
IPN-IDAHO PHYSICIANS NETWORK
ID
Enumeration date
12/02/2015
Last updated
10/03/2023
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