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General NPI Number Information
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NPI Number | 1275948580
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Entity Type | Individual
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Provider Name | KRISTIN FAHSEL NP
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Gender | Female
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 4900 BROAD RD RM 1139
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City | SYRACUSE
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State | NY
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Zip | 13215-2265
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Country | US
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Telephone | 315-492-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 251 SALINA MEADOWS PKWY STE 100
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City | SYRACUSE
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State | NY
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Zip | 13212-4516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 338823
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License Number State | NY
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