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General NPI Number Information
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NPI Number | 1578270757
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Entity Type | Individual
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Provider Name | CAITLIN FAZIO NP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2022
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 378 FRIES MILLS RD
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City | SEWELL
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State | NJ
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Zip | 08080
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Country | US
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Telephone | 800-427-1902
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Fax |
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Provider Business Mailing Address
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Address Line | 333 N SUMMIT ST FL 15
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City | TOLEDO
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State | OH
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Zip | 43604-2615
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ01390300
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License Number State | NJ
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