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NPI Code Detail

MEDICARE: CAROLE C FAVERO LMT, AP, DOM

MEDICARE: CAROLE C FAVERO LMT, AP, DOM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturistAP2355FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AP2355OTHERFLLICENSE NUMBER
2MA40554OTHERFLLMT LICENSE

General Provider Information

NPI Number : 1265656706
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLE C FAVERO LMT, AP, DOM
Provider Business Mailing Address
First Line : 3693 OCONTO AVE
Second Line :
City : NORTH PORT
State : FL
Zip : 34286-4213
Country : US
Telephone Number : 941-685-1737
Fax Number : 941-429-9951
Provider Business Practice Location Address
First Line : 3693 OCONTO AVE
Second Line :
City : NORTH PORT
State : FL
Zip : 34286-4213
Country : US
Telephone Number : 941-685-1737
Fax Number : 941-429-9951
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2007
Last Update Date : 07/08/2007

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