Provider Demographics
NPI:1124027180
Name:FAHS, DEBORAH B (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:B
Last Name:FAHS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N MAIN STREET EXT
Mailing Address - Street 2:BLDG 2 SUITE C2
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2400
Mailing Address - Country:US
Mailing Address - Phone:203-269-9778
Mailing Address - Fax:203-949-1544
Practice Address - Street 1:850 N MAIN STREET EXT.
Practice Address - Street 2:BLDG 2 SUITE C2
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-269-9778
Practice Address - Fax:203-949-1544
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily