1073891867 NPI number — MRS. KIRBY MAE FAZIO FNP-BC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073891867 NPI number — MRS. KIRBY MAE FAZIO FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAZIO
Provider First Name:
KIRBY
Provider Middle Name:
MAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DRUSCHEL
Provider Other First Name:
KIRBY
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
STUDENT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073891867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-0722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-242-7106
Provider Business Mailing Address Fax Number:
304-242-7108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 N 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 300N
Provider Business Practice Location Address City Name:
MARTINS FERRY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43935-1648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-633-4765
Provider Business Practice Location Address Fax Number:
740-633-6450
Provider Enumeration Date:
07/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  71224 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: 71224 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 71224 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: RN.374015 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 71224 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN.374015 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810021489 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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