Organization
FAIRFAX ACNE & DERMATOLOGY SERVICES, PC
Active
Other names
Fairfax Acne & Dermatology, PC
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA L FAIRFAX DCNP (OWNER)
(508) 404-3853
Entity
Organization
Contact information
Practice address
1275 WAMPANOAG TRAIL, STE. 6, EAST PROVIDENCE, RI 02915-1217
(508) 404-4853
Mailing address
1275 WAMPANOAG TRAIL, STE. 6, EAST PROVIDENCE, RI 02915-1217
(508) 404-4853
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/31/2022
Last updated
10/31/2022
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