Individual
AMBER MARIE FAHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1370 W D ST, NORTH WILKESBORO, NC 28659-3506
(336) 716-2255
Mailing address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-3000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-05142
NC
363A00000X
Physician Assistant
3738-23
WI
363A00000X
Physician Assistant
Primary
PA61849
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568877405
—
WI
Enumeration date
06/30/2014
Last updated
11/30/2022
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