Provider Demographics
NPI:1881679009
Name:DEL FAVERO, EUGENIA MARIE (GNP)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:MARIE
Last Name:DEL FAVERO
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 MEADOW VIEW LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9240
Mailing Address - Country:US
Mailing Address - Phone:315-253-4022
Mailing Address - Fax:
Practice Address - Street 1:85 THORNTON AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4654
Practice Address - Country:US
Practice Address - Phone:315-253-7351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340020363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR53250Medicare UPIN