Provider Demographics
NPI:1922323724
Name:FAVRE, MARTHA LOUISE
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LOUISE
Last Name:FAVRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PEARL ST
Mailing Address - Street 2:FITCHBURG STATE COLLEGE STUDENT HEALTH SERVICES
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-2697
Mailing Address - Country:US
Mailing Address - Phone:978-665-3344
Mailing Address - Fax:978-665-3641
Practice Address - Street 1:160 PEARL ST
Practice Address - Street 2:FITCHBURG STATE COLLEGE STUDENT HEALTH SERVICES
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-2697
Practice Address - Country:US
Practice Address - Phone:978-665-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily