Provider Demographics
NPI:1659312478
Name:FAHERTY, GERALDINE (RNP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:FAHERTY
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNP
Mailing Address - Street 1:275 MARTINE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1516
Mailing Address - Country:US
Mailing Address - Phone:508-675-4683
Mailing Address - Fax:508-675-7905
Practice Address - Street 1:455 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2759
Practice Address - Country:US
Practice Address - Phone:401-737-7010
Practice Address - Fax:401-736-1009
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN34082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner