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General NPI Number Information
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NPI Number | 1508090440
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Entity Type | Individual
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Provider Name | ROSE M FAYETTE ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 1400 VFW PKWY
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City | WEST ROXBURY
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State | MA
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Zip | 02132-4927
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Country | US
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Telephone | 857-203-6140
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Fax |
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Provider Business Mailing Address
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Address Line | 123 SCHOOL ST
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City | AVON
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State | MA
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Zip | 02322-1869
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Country | US
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Telephone | 617-763-8526
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN230374
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 230374
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License Number State | MA
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