Provider Demographics
NPI:1275864936
Name:FAY, ERIN THERESE (PNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:THERESE
Last Name:FAY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2169 7 FRONTIER RD.
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9646
Mailing Address - Country:US
Mailing Address - Phone:559-903-1023
Mailing Address - Fax:
Practice Address - Street 1:21697 FRONTIER RD.
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-9646
Practice Address - Country:US
Practice Address - Phone:559-903-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19473363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics