Individual
FARIAHH FAZIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2 GOOD SAMARITAN WAY STE 235, MOUNT VERNON, IL 62864-2476
(618) 899-3980
Mailing address
PO BOX 955860, SAINT LOUIS, MO 63195-2551
(636) 498-5944
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209019228
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209019228
LICENSE
IL
Enumeration date
10/28/2019
Last updated
10/19/2020
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