Provider Demographics
NPI:1649699182
Name:FATUPAITO, FARAH ANN (PMHRN)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:ANN
Last Name:FATUPAITO
Suffix:
Gender:F
Credentials:PMHRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 MENDOTA ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1096
Mailing Address - Country:US
Mailing Address - Phone:608-280-3192
Mailing Address - Fax:608-280-3185
Practice Address - Street 1:1320 MENDOTA ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1096
Practice Address - Country:US
Practice Address - Phone:608-280-3192
Practice Address - Fax:608-280-3185
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171392-30163W00000X
WI2013015810163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse