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General NPI Number Information
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NPI Number | 1356457147
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Entity Type | Individual
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Provider Name | NICOLE MARIE FAVA ATC
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 111 VICTORIA RD
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City | ASHEVILLE
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State | NC
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Zip | 28801-4811
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Country | US
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Telephone | 828-252-7331
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Fax | 828-253-1123
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Provider Business Mailing Address
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Address Line | 623 HAW CREEK MEWS PL
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City | ASHEVILLE
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State | NC
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Zip | 28805-7902
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Country | US
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Telephone | 919-619-4837
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Fax | 828-253-1123
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-07893
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License Number State | NC
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