Provider Demographics
NPI:1639353667
Name:CHRISTINA FAHERTY, ARNP, PLLC
Entity Type:Organization
Organization Name:CHRISTINA FAHERTY, ARNP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:603-886-7110
Mailing Address - Street 1:5 PINE ST EXTENSION #6 MILL ANNEX
Mailing Address - Street 2:SUITE K
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-886-7110
Mailing Address - Fax:
Practice Address - Street 1:5 PINE ST EXTENSION #6 MILL ANNEX
Practice Address - Street 2:SUITE K
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-886-7110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30344907Medicaid