Provider Demographics
NPI:1831307024
Name:FAUCHER, SHIRLEY N (APRN)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:N
Last Name:FAUCHER
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 1:29 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-1823
Mailing Address - Country:US
Mailing Address - Phone:508-765-9167
Mailing Address - Fax:508-765-3128
Practice Address - Street 1:29 PINE ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1823
Practice Address - Country:US
Practice Address - Phone:508-765-9167
Practice Address - Fax:508-765-3128
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA125044363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQX1082Medicare PIN