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General NPI Number Information
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NPI Number | 1548219728
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Entity Type | Individual
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Provider Name | FAYE MEMOLO PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 187 MAIN ST APT. 6
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City | COLEBROOK
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State | NH
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Zip | 03576-2012
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Country | US
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Telephone | 603-348-0259
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Fax |
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Provider Business Mailing Address
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Address Line | 187 MAIN ST., APT. 6 NATIONAL DERMATOLOGY HEALTHCARE/FAYE MEMOLO, PA-C
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City | COLEBROOK
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State | NH
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Zip | 03576
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Country | US
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Telephone | 603-348-0259
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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 | 0403 P
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License Number State | NH
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