Healthcare Provider Details

I. General information

NPI: 1528150158
Provider Name (Legal Business Name): MIRIAM E FAHRER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRIAM EDDINS

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 EDGEWOOD AVE
BURLINGTON NC
27215-4505
US

IV. Provider business mailing address

PO BOX 10414
LARGO FL
33773-0414
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-6074
  • Fax: 866-341-7509
Mailing address:
  • Phone: 800-632-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN050772
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: