Individual
MARY LYNN FAHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1 PORTSMOUTH AVE, STRATHAM, NH 03885-2585
(603) 943-3600
(603) 630-1009
Mailing address
100 SHATTUCK WAY, STE 100, NEWINGTON, NH 03801-8007
(603) 431-6677
(603) 610-2232
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN203678
MA
363LF0000X
Family Nurse Practitioner
Primary
027443-23-03
NH
363LP2300X
Primary Care Nurse Practitioner
027443-23-03
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
213938
CIGNA
NH
01
—
2305915YPNH01
ANTHEM BCBS
NH
05
—
30008013
—
NH
01
—
7576040-004
CIGNA
NH
Enumeration date
06/20/2005
Last updated
11/26/2024
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