Healthcare Provider Details

I. General information

NPI: 1841009693
Provider Name (Legal Business Name): BASTIAN ANDREW FAGGINGER-AUER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 COMMONS ST
RUTLAND VT
05701-4652
US

IV. Provider business mailing address

9 COMMONS ST
RUTLAND VT
05701-4652
US

V. Phone/Fax

Practice location:
  • Phone: 802-779-7522
  • Fax: 802-735-9662
Mailing address:
  • Phone: 802-779-7522
  • Fax: 802-735-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0137621
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: