Healthcare Provider Details

I. General information

NPI: 1578270757
Provider Name (Legal Business Name): CAITLIN FAZIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 FRIES MILLS RD
SEWELL NJ
08080
US

IV. Provider business mailing address

333 N SUMMIT ST FL 15
TOLEDO OH
43604-2615
US

V. Phone/Fax

Practice location:
  • Phone: 800-427-1902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ01390300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: