MEDICARE: ANTOINETTE MARIE FEARON-EUGENE

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922501022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE MARIE FEARON-EUGENE

Provider Business Mailing Address
First Line	:	17 AUBURN ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06112-2002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 AUBURN ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06112-2002
Country	:	US
Telephone Number	:	860-212-1497
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	03/14/2018

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Directions to “ ANTOINETTE MARIE FEARON-EUGENE ” Practice Location

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