Individual
KATHLEEN FAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
593 EDDY STREET, JANE BROWN, 2 SOUTH, PROVIDENCE, RI 02903-4923
(401) 444-5943
(401) 444-4216
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4513
(401) 444-6779
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN34380
RI
363LA2100X
Acute Care Nurse Practitioner
Primary
NPP37680
RI
Other
Enumeration date
01/26/2012
Last updated
12/05/2018
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