Provider Demographics
NPI:1265656706
Name:FAVERO, CAROLE C (LMT, AP, DOM)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:C
Last Name:FAVERO
Suffix:
Gender:F
Credentials:LMT, AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3693 OCONTO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-4213
Mailing Address - Country:US
Mailing Address - Phone:941-685-1737
Mailing Address - Fax:941-429-9951
Practice Address - Street 1:3693 OCONTO AVE
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-4213
Practice Address - Country:US
Practice Address - Phone:941-685-1737
Practice Address - Fax:941-429-9951
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2355171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP2355OtherLICENSE NUMBER
FLMA40554OtherLMT LICENSE