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General NPI Number Information
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NPI Number | 1376067868
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Entity Type | Individual
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Provider Name | ELIZABETH GRILLIOT FAHEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 200 E CHESTNUT ST STE 303
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City | LOUISVILLE
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State | KY
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Zip | 40202-1831
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Country | US
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Telephone | 502-629-5552
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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