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Individual

CONSTANCE S FAIR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
3900 WOODLAND AVE, PHILADELPHIA, PA 19104-4551
(252) 241-9898
Mailing address
401 WITLEY RD, WYNNEWOOD, PA 19096-2424
(252) 241-9898

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-01710
NC
364SP2800X
Perioperative Clinical Nurse Specialist
Primary
MA060918
PA

Other

Enumeration date
02/05/2009
Last updated
06/22/2021
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