Individual
MS. DIANE E FAHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
755 CAMPBELL AVE, SUITE 2, WEST HAVEN, CT 06516-3715
(203) 889-2297
(203) 889-2249
Mailing address
755 CAMPBELL AVE, SUITE 2, WEST HAVEN, CT 06516-3715
(203) 889-2297
(203) 889-2249
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
000373
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000373
LICENSE NUMBER
CT
05
—
001177757
—
CT
Enumeration date
12/27/2006
Last updated
05/03/2016
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