=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841009693
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BASTIAN ANDREW FAGGINGER-AUER APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2025
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 COMMONS ST
-----------------------------------------------------
City | RUTLAND
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05701-4652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-779-7522
-----------------------------------------------------
Fax | 802-735-9662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 COMMONS ST
-----------------------------------------------------
City | RUTLAND
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05701-4652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-779-7522
-----------------------------------------------------
Fax | 802-735-9662
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 101.0137621
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------