Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 209.006373 | IL |
NPI | 1003056250 |
---|---|
Provider Name | Mrs. Karen Joyce Fahey |
First Address | Geneva, IL 60134-2578 |
Second Address | Geneva, IL 60134-2578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2009 |
Last Update Date | 04/08/2011 |