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Individual
NICOLE SUZANNE FANNING
Active
Individual
NICOLE SUZANNE FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
NULL
207V00000X
Obstetrics & Gynecology Physician
0101256369
VA
207V00000X
Obstetrics & Gynecology Physician
Primary
D0084730
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
VA
Other
Enumeration date
05/31/2012
Last updated
08/07/2018
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