MEDICARE: MRS. JAIME ELIZABETH FAHY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN00779	RI

General Provider Information

NPI Number	:	1518322270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAIME ELIZABETH FAHY FNP-C

Provider Business Mailing Address
First Line	:	43 JEFFERSON BLVD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02888-1027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1454 S COUNTY TRL
Second Line	:
City	:	EAST GREENWICH
State	:	RI
Zip	:	02818-1749
Country	:	US
Telephone Number	:	401-649-4050
Fax Number	:	401-649-4051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2015
Last Update Date	:	09/17/2020

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