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General NPI Number Information
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NPI Number | 1952564981
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Entity Type | Individual
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Provider Name | MRS. BEVERLY A FAILLE
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Gender | Female
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 300 BIRNIE AVE
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City | SPRINGFIELD
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State | MA
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Zip | 01107-1107
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Country | US
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Telephone | 413-785-4666
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Fax | 413-846-4756
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Provider Business Mailing Address
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Address Line | 300 BIRNIE AVE SUITE 201
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City | SPRINGFIELD
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State | MA
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Zip | 01107-1107
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Country | US
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Telephone | 413-785-4666
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Fax | 413-846-4756
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 255880
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 2007007224-28
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License Number State | MA
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